- TEKsystems (Dallas, TX)
- …and submit enrollment and re-enrollment applications for healthcare providers to Medicare , Medicaid, and commercial insurance plans. Maintain accurate and up-to-date ... provider enrollment, credentialing, or healthcare administration. Strong understanding of Medicare , Medicaid, and commercial insurance enrollment processes. Excellent organizational,… more
- Molina Healthcare (Houston, TX)
- …facility members in custodial beds to return to the community. * Initiates referrals for Medicare and waiver process if member is not already Medicare or waiver ... established. * Tracks referrals and case documents via designated state systems. * Tracks activities occurring within the transitional, assessment and authorization processes - using internal systems and designated state systems, and reports results to… more
- Molina Healthcare (Houston, TX)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and ... * Customer/provider experience in a managed care organization (Medicaid, Medicare , Marketplace and/or other government-sponsored program), or medical office/hospital… more
- ConvaTec (Spring, TX)
- …phone calls from clients regarding orders & customer service issues + Request Medicare documentation on Medicare clients + Contacts HH agencies to coordinate ... sending supplies + Make entries as appropriate in Medtrack an internal Microsoft Access database + Place orders in Medtrack + Change orders in Medtrack + Support Team Supervisor on miscellaneous projects + Obtain verbal authorization for supplies from… more
- Molina Healthcare (Fort Worth, TX)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Molina Healthcare (San Antonio, TX)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- Molina Healthcare (Fort Worth, TX)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… more
- Novo Nordisk (Houston, TX)
- …impact + Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... Requirements, Step Therapy, Coverage Gap, Copays, and Deductibles and the impact on customer decisions + Demonstrates understanding of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems, and Local Clinics and uses this to… more
- Health Care Service Corporation (Mcallen, TX)
- …+ Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business + Prior experiences teaching/training others ... on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers. + **Client-Site Location:** This is a field based position and requires the individual to be at provider offices up to 3 days weekly within the assigned… more
- ChenMed (Houston, TX)
- …approved (when needed). + Schedules patient (Preferred Providers List of Specialist ) and notifies them of appointment information, including, date, time, location, ... and how patient was notified. + Referrals have been sent to specialist office & confirmed receipt. + Prepares and actively participates during physician/clinician… more