- Prime Therapeutics (Austin, TX)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Molina Healthcare (Austin, TX)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Intermountain Health (Austin, TX)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... optimization of reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and Hospital Acquired… more
- HCA Healthcare (San Antonio, TX)
- …clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical ... you will need:** Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare ) and Local… more
- CenterWell (Alice, TX)
- …protocol defined byClinical Leadership. + Meets with RMD about quality of care, review of outcome data,policy, procedure and records issues. + Participates in ... two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in… more
- TEKsystems (Dallas, TX)
- …Ensure timely and accurate billing of claims via electronic or paper to Medicare , Medicaid, and Commercial Insurances in accordance with policy using primarily Niko ... claims and/or balances that are deemed uncollectible to Financial Patient Responsibility Review or Write Off Queues timely and appropriately. * Assist and… more
- TEKsystems (Dallas, TX)
- …and denials. The ideal candidate will have a strong understanding of Medicare , Medicaid, and Commercial Insurance billing, particularly in the DME/HME space. Key ... Responsibilities: + Submit claims via Niko Health and Salesforce to Medicare , Medicaid, and Commercial payers. + Post payments and denials from EOBs, ensuring… more
- Elevance Health (Houston, TX)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more
- HCA Healthcare (Austin, TX)
- …public nursing or acute hospital nursing experience + Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly ... health, public nursing or acute hospital nursing experience Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS… more
- Prime Therapeutics (Austin, TX)
- …related partner/customer relationships including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director, Pharm ... + Direct the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as… more