- Abbott (Plano, TX)
- …experience + General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . ... Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Experience in medical device or DME Billing a plus +… more
- Houston Methodist (Houston, TX)
- …care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Centene Corporation (Austin, TX)
- …candidate will have:_** + **_Knowledge of Dual contract requirements (eg, Medicare -Medicaid plans)_** + **_Experience managing external audits and communicating with ... regulatory agencies_** + **_Ability to review deliverables and provide clear, actionable feedback_** + **_Skilled in developing and maintaining audit reporting,… more
- Kelsey-Seybold Clinic (Houston, TX)
- …multidisciplinary team, and experience with clinical pathology to include peripheral smear review and knowledge of CLIA regulatory requirements as it applies to ... compliance with departmental key performic indicators such as turnaround time and peer review metrics. + Perform frozen sections on a rotating basis. + Perform rapid… more
- Prime Therapeutics (Austin, TX)
- …help ensure efficient and effective solutions are implemented + Perform and review detail plans to address complex compliance issues by identifying goals, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Datavant (Austin, TX)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Aveanna Healthcare (Houston, TX)
- …and "Re-evaluations" to transition patients from facilities to home care. + Review physicians' orders and update care plans and documentation as needed. + ... to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more
- Zelis (Plano, TX)
- …concerns with minimal supervision. + Conduct regular strategic client calls to review progress, resolve issues, align on goals, and build long-term relationships. + ... client experience. + Act as a subject matter expert (SME) in Medicare pricing, reimbursement methodologies, and Zelis platform capabilities. + Mentor junior team… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization ... in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially... & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in "Buy and Bill"… more
- Prime Therapeutics (Austin, TX)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid, Exchange, Commercial, Employer Group) Every employee must understand, comply… more