Administrative Assistant – HCS Medicaid Program - Houston, TX

Actively participate in HEDIS projects for the organization as a nurse auditor. Assist team with data analytics to assure accurate and complete quantitative analysis of HEDIS data. · ...

+The Service Coordination Admin assists with submission and tracking of assessments for STAR+PLUS program. · +High School Diploma or GED required. · 1 year of experience in healthcare/managed care setting. · +ResponsibilitiesMaintain assessment due dates for timely completion by ...

The incumbent shall serve as the first line coach to the UM Precertification and Concurrent Review Coordinators. Improving Members' experiences is at the heart of every Community position. · Serve as the first line coach to the UM Coordinators. An on the floor floater · Data entr ...

+The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a patient's risk score, · by mapping diagnoses to Hierarchical Condition Categories (HCCs) while adhering t ...

The Claims Adjustment Analyst supports the review and closure of payment disputes including corrected claims, · retro authorizations, and incorrect denial requests in a timely manner. · ...

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: · • Med ...

Job summary · Claims Analyst is responsible for processing professional, inpatient, and outpatient facility claims. · Responsibilities · ...

A Qualified Mental Health Professional (QMHP) delivers direct mental health services under supervision within state-regulated systems. · ...

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: · ' Med ...

The SIU Investigator is responsible for detecting, investigating, and preventing potential fraud, waste, and abuse (FWA) within claims and provider billing. · Conducts pre- and post payment reviews. · Cordinates investigative efforts with internal and external stakeholders. · ...

The Chief Medical Officer (CMO) has accountability for the clinical strategy for Medical Affairs, Quality, and Medical Management all while building sustainable programs that promote innovative ways to achieve improved outcomes for our members. · ...

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: · • Med ...

The Chief Medical Officer has accountability for the clinical strategy for Medical Affairs, Quality, and Medical Management all while building sustainable programs that promote innovative ways to achieve improved outcomes for our members. · ...

Actively participate in HEDIS projects for the organization as a nurse auditor. · ...

About Us: · Exceptional Wellness ABA Therapy Services LLC is a growing, mission-driven behavioral health organization dedicated to providing high-quality Applied Behavior Analysis (ABA) services to children and families across Texas. We focus on individualized care, clinical exce ...

The Certified Medical Coder will lead administrative and operational support tasks that require independent review and judgment relative to coding concerns. · ...

The Behavioral Health Clinical Reviewer is responsible for evaluating clinical records and referral documentation to determine eligibility and fit for Nexus behavioral health and neurodevelopmental programs. · Master's degree in Social Work, Clinical Psychology, Counseling, Appli ...

The Cyber Security Architect is a senior-level role responsible for designing and implementing secure technology architectures that protect sensitive healthcare data, · Develop and maintain enterprise security architecture aligned with organizational goals and regulatory requirem ...

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: · • Med ...

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: · • Med ...