- Molina Healthcare (Dallas, TX)
- …oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School ... regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part D, Medicaid,… more
- Humana (Austin, TX)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...or similar pharmacy practice experience + Board Certified Pharmacotherapy Specialist (BCPS) + MBA, pharmacoeconomics or health outcomes training… more
- Texas Health Resources (Arlington, TX)
- …Support & Case Review - Conduct additional reviews to assist departments handling Medicare , OIG, or non- Medicare denials. Provide expert analysis on coding, ... Health Information Administrator Upon Hire Required Or CCS - Certified Coding Specialist Upon Hire Required Or CPC - Certified Professional Coder Upon Hire… more
- HCA Healthcare (San Antonio, TX)
- …regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with medical necessity, ... you will need:** Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare ) and Local… more
- Abbott (Plano, TX)
- …location in **Plano, TX** currently has an opportunity for a **Patient Therapy Access** ** Specialist ** (PTA). This is an in office 5 days a week position. Preferred ... hours 8am to 5pm. As a PTA Specialist you are responsible for facilitating and assisting Abbott patients with the pre-certification, pre-determination and… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a family doctor is not necessary to schedule an appointment with a Kelsey-Seybold specialist , but the family doctor is an important part of the multispecialty team. ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more
- Molina Healthcare (Austin, TX)
- …Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically ... appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret… more
- Molina Healthcare (TX)
- …compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... delegated groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality… more
- CVS Health (Austin, TX)
- …within budgeted costs. **What you will do** + Acts as a top-level specialist on project management and develops a comprehensive plan that encompasses objectives, ... Qualifications** + Pharmacist + 7-10 years work experience in healthcare + Medicare and/or Medicare -Medicaid Integrated Product Experience + Experience with Part… more
- Evolent (Austin, TX)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more