POSITION SUMMARY /RESPONSIBILITIES
Community First Health Plans, Inc. (Community First) is a Health Maintenance Organization (HMO) providing health care services to Medicaid, CHIP, Medicare, and Marketplace recipients. Community First also provides commercial and self-funded insurance to members. Community First must ensure that all operations are aligned with the regulatory requirements of the Texas Health and Human Services Commission (HHSC), the Texas Department of Insurance (TDI), the Centers for Medicare and Medicaid Services (CMS), and the National Association of Insurance Commissioners (NAIC). Collaborates with all leaders and departments throughout the course of the audit function, promoting a team-oriented environment.
EDUCATION/EXPERIENCE
Bachelor's degree is required in accounting or healthcare-related field with at least three years' experience in professional healthcare audit services, interpretation of Texas Medicaid Managed Care regulations, Texas Department of Insurance regulations, and/or HHSC OIG Medicaid Managed Care SIU regulations. Experience with anti-fraud detection and prevention is required. A master's degree in accounting or related field is preferred. Supervisory experience is preferred. Experience with NAIC Model Audit Rule (MAR) audits and Enterprise Risk Management (ERM) is preferred. Must possess at least one or more relevant professional certifications (i.e., CHC, CIA, CPA, CFE). Preference will be given to a Certified Internal Auditor with AHIMA Coding Certification. Expert knowledge of ICD, CPT, HCPCS coding classifications and DRG, APC, and ASC payment methodology is highly desirable.
...provides equipment and supplies to support QAPI efforts. The Administrator is the Compliance Liaison of the facility, with a... ...determine experience required. The ability to be a licensed as a Nursing Home Administrator in the state of practice is required. Other...
...room shifts or events such as weddings, banquets, corporate gatherings, etc. Handle cash... ...describes at a high level what a Banquet Server does, but no document can anticipate every... ...to the people and places were lucky to call home. Our workforce is diverse. Our team...
...Job Description An experienced consulting professional who has an understanding of solutions, industry best practices, multiple business... ...tasks that need independent judgment, in order to implement Oracle products and technology to meet customer needs. Applies Oracle...
Position Type: Maintenance/Custodial/Custodian Date Posted: 11/6/2025 Location: District-wide Closing Date: until filled Description: The hourly rate is $18.46. Attachment(s): ~ DISTRICT 304 On-Call Substitute Custodian 2015.pdf
...A dynamic parking service provider is seeking individuals for a Parking Enforcement Opportunity in Atlantic City, NJ. This flexible gig allows you to earn by scanning license plates and issuing tickets with a smartphone app. Ideal candidates are 18+ and can choose their...