- Sedgwick (Austin, TX)
- …Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations. + Creates ... Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To...culture. + Passionate about creativity. + Craves culture of support , both giving and receiving. + Thrives when everyone… more
- Molina Healthcare (San Antonio, TX)
- …and within Molina State plans for intervention development and execution to support Medicare Stars measure level improvement and program revenue maximization ... existing healthcare quality improvement initiatives and education programs supporting Medicare Star Ratings improvement for Clinical HEDIS measures. Responsible for… more
- Elevance Health (Grand Prairie, TX)
- …to transform federal health programs. The **Audit and Reimbursement Senior** will support our Medicare Administrative Contract (MAC) with the federal government ... and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost...Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A… more
- Humana (Austin, TX)
- …weekend coverage + Develop collaborative relationships with Team and key partners within the Medicare Line of Business. + Support Home Solutions as needed + ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare… more
- Humana (Austin, TX)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana… more
- Baylor Scott & White Health (Temple, TX)
- …for MA Stars will lead strategic initiatives to achieve and sustain exceptional Medicare Advantage Star Ratings performance across the health plan. This role is ... Role** * Strategic Leadership: Develop and execute strategies to meet and exceed Medicare Stars performance targets to achieve and maintain 4+ star ratings. Drive… more
- Houston Methodist (Katy, TX)
- …HB Epic AR management experience + Strong working knowledge of Facility Medicare (Part A) guidelines. + Problem solving thought leader with proven execution ... to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash… more
- Molina Healthcare (San Antonio, TX)
- …Leads and directs team that provides strategic, process improvements, and operational support to advance the goals and objectives of the Integrated Duals program. ... Affairs to assess and provide analyses for proposed changes to Medicare , and other government-sponsored healthcare program contracts, governing regulations and new… more
- Molina Healthcare (Fort Worth, TX)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of… more