- Insight Global (Plano, TX)
- …chart reviews to validate that assigned codes accurately reflect the patient's clinical picture. Utilize ICD-10-CM and ICD-10-PCS coding systems to ensure ... Category (HCC) capture, Case Mix Index (CMI), and other coding factors. Apply current clinical criteria including MCG, InterQual, payer clinical policy… more
- Waystar (Austin, TX)
- …+ Experience constructing a business case for product initiatives + Previous work with clinical decision support, autonomous coding , or CAC tools. + Knowledge of ... market research. + Partner with engineering, data science, product design, and clinical SMEs to deliver high-quality, high-impact, and timely releases using Agile… more
- Humana (Austin, TX)
- …May apply intermediate mathematical skills. **Where you Come In** The Medical Coding Coordinator extracts clinical information from a variety of medical ... a code editing related denial or financial recovery. The Medical Coding Coordinator performs advanced administrative, operational, and customer support duties that… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Humana (Austin, TX)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- CenterWell (Austin, TX)
- …conflict resolution skills. An aspect of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Austin, TX)
- …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference… more
- Humana (Austin, TX)
- …Other duties include, but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including ... and work is assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference… more
- Abbott (Austin, TX)
- …people with diabetes from routine fingersticks. The **Associate Manager of Clinical Trial Reimbursement** is responsible for implementing and managing clinical ... processes to secure Medicare and private payer reimbursement for designated clinical trials. This position will operate with limited day-to-day direction and… more
- MD Anderson Cancer Center (Houston, TX)
- *General Duties* Provides clinical expertise in patient care management and provides an appropriate teaching environment for fellows, residents, and students in the ... The Assistant Professor will participate in the development of clinical research studies and will be independently responsible for...experience. * Visually review for proper ICD-10 and CPT coding and approve all charge documents within 5 working… more
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