- CVS Health (Austin, TX)
- …day. Aetna's Revenue Integrity team is hiring Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a critical part in ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...and internal policies and procedures. + Proven ability to support coding judgment and decisions using industry standard evidence… more
- Humana (Austin, TX)
- …standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental ... experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of… more
- HCA Healthcare (Pearland, TX)
- …Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. ... banking partnerships + Education assistance (tuition, student loan, certification support , dependent scholarships) + Colleague recognition program + Time Away… more
- Humana (Austin, TX)
- …maintaining optimum health. We provide telephonic outreach to assess and support their health, offering education, identifying resources, and helping remove barriers ... to day flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare , Medicaid, and/or and Group Account members and create actionable and… more
- Robert Half Management Resources (Dallas, TX)
- …requirements. * Oversee the timely submission of Notice of Elections to Medicare , ensuring deadlines are met. * Collaborate with skilled nursing facilities and ... * Serve as the primary resource for hospice billing software, providing user support and training as needed. * Generate and distribute monthly invoices for physician… more
- Humana (Austin, TX)
- …Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or ... or Bachelor's degree in a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage experience + Bilingual is a… more
- Kelsey-Seybold Clinic (Houston, TX)
- …Physician Assistant Examiners. Cardiopulmonary Resuscitation Certification (CPR), Basic Cardiac Life Support (BCLS) have or obtain Advanced Cardiac Life Support ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more
- Evolent (Austin, TX)
- …with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a key resource for Initial Clinical Reviewers, ... to the Utilization Management process, interpretation, guidelines and/or system support . + On a requested basis, may function as...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Prime Therapeutics (Austin, TX)
- …identify compliance requirements, assess risks, and recommend compliant solutions that support enterprise goals + Conducts analysis to create written reports, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- ChenMed (Houston, TX)
- …long-term relationships and higher level of satisfaction with key specialists with support from network director or associate director. + Conducts site visits to ... resolves issues, educates staff/providers on policies and certifies specialists with support of network director or associate director. + Establishes consistent and… more