- Molina Healthcare (Fort Worth, TX)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Centene Corporation (Austin, TX)
- …planning and delivery of strategic programs and complex, large-scale enterprise-wide Medicare designs to execute defined requirements and meet company strategic ... executive level discussion. + End-to-end development, filing and execution of the Medicare Supplemental dental, vision and hearing benefits. Program Manager will own… more
- Humana (Austin, TX)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Austin, TX)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Molina Healthcare (Fort Worth, TX)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and...for additional vendor funding as required. + Oversee the review , reconciliation, and approval of invoices for payment of… more
- Molina Healthcare (San Antonio, TX)
- …and expertise in the performance of prior authorization, inpatient concurrent review , discharge planning, case management and interdisciplinary care team activities. ... Medical Directors + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in Medicine *… more
- Molina Healthcare (TX)
- …and/or pharmacy internal monitors who support processes involved with the review of non-formulary drugs or other drugs requiring prior authorization. + ... speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is… more
- Molina Healthcare (Fort Worth, TX)
- …internal compliance program, including annual, periodic, focal, etc. audits. * Request, review and perform oversight of internal corrective action plans (CAPs) for ... it relates to the finding. * Performs support via review and approval for Corporate Operations policies, procedures, guidelines...years or more + 5 years of experience in Medicare , DSNP and CSNP population, Enrollment, A&G, Claims, Compliance,… more
- Guidehouse (San Antonio, TX)
- …Antonio, TX offices and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + ... Customer Service + Billing + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist… more
- CVS Health (Austin, TX)
- …to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / ... Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The… more