- Intermountain Health (Austin, TX)
- **Job Description:** Provides assistance to the Reimbursement Manager to control or review the following areas for government and third party payers for assigned ... appropriately recorded, reviewed, and reconciled. Reviews or prepares monthly Medicare and Medicaid contractual allowance calculations using technically acceptable… more
- Providence (TX)
- …training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer reporting, ... + Act as a resource to fellow caregivers for Medicare Secondary Payer reporting of third-party claim payments and...focus topics to claims leaders based on trending analysis. Review claim files from a quality assurance perspective to… more
- Molina Healthcare (TX)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... with a consistent focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject matter expert to colleagues… more
- Humana (Austin, TX)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Centene Corporation (Austin, TX)
- …Opportunity**_** **_The ideal candidate will have:_** + **_Deep knowledge of the Medicare Advantage program, with hands-on experience in Dual Eligible Special Needs ... (compliance, product, or operations)._** + **_Research skills to track and review policy and regulatory changes._** + **_Project management experience leading… more
- Prime Therapeutics (Austin, TX)
- …qualified entities across all lines of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs, including but ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...$17.85 - $25.48 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Texas Health Resources (Arlington, TX)
- …. Obtain/verify physician order for therapy and validate for appropriateness. . Review available medical records and obtain pertinent medical history from therapist ... aspects of assessment and plan of care in accordance with departmental, TJC, Medicare , and other applicable regulatory guidelines. . Documents all aspects of each… more
- CenterWell (San Antonio, TX)
- …defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential ... you will be required to be screened for TB **Preferred Qualifications:** + Medicare Provider Number + Minimum of two to five years directly applicable experience… more
- Gentiva (Lubbock, TX)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... new physicians and facilities, durable medical equipment (DME) pickup, Medicare patient eligibility, obtaining authorization and reauthorization as needed,… more
- Prime Therapeutics (Austin, TX)
- …strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality ... goals + Drive the client quality strategy for all lines of business ( Medicare , Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert… more