- Prime Therapeutics (Austin, TX)
- …This role is dedicated to the government program compliance in the Medicare , Medicaid, and the Affordable Care Act (ACA) spaces. **Responsibilities** + Executes ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- Evolent (Austin, TX)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Austin, TX)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Evolent (Austin, TX)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Austin, TX)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Prime Therapeutics (Austin, TX)
- …benefit design and pricing support for all Prime's lines of business (commercial, Medicare and Medicaid). This role will also provide actuarial support in complex ... support, and maintain financial and complex actuarial models + Lead, perform, and review data analyses, reporting, and projections + Lead, perform, and review … more
- HCA Healthcare (Dallas, TX)
- …**Job Summary and Qualifications** As Reimbursement Manager, you will complete Medicare and Medicaid cost reports to obtain appropriate reimbursement from these ... company's reimbursement policies and procedures. Your responsibilities will include: + Prepare Medicare and Medicaid cost reports to obtain all amounts due from… more
- Prime Therapeutics (Austin, TX)
- …design and pricing support for all Prime's lines of business (commercial, Medicare and Medicaid). **Responsibilities** + Build, support, and maintain financial and ... actuarial models + Perform and review data analyses, reporting, and projections...healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 1 year… more
- Methodist Health System (Dallas, TX)
- …but not limited to, state specific health care laws and regulations, Medicare /Medicaid rules, fraud and abuse including Stark and anti-kickback laws and regulations, ... + The AGC is the Office of Legal Affairs liaison to the System Quality Review Committee, a committee of the MHS Board, the Corporate Medical Board (the system level… more
- Sunny Springs Nursing Center (Sulphur Springs, TX)
- …Assist with coordination and management of the daily stand up meeting, to include review of resident care and the setting of the assessment reference date(s). * ... of the MDS with information obtained via medical record review as well as observation and interview with facility...assists, and instructs staff in the RAI Process, PPS Medicare , Medicaid (Case Mix as required) and clinical computer… more