- Houston Methodist (Sugar Land, TX)
- …denials for level of care, medical necessity, and as appropriate, DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management ... Specialist position communicates clinical information utilizing various resources and skills to reduce significant financial risk and exposure caused by unnecessary services provided. This position facilitates accurate reimbursement and provides feedback for… more
- Houston Methodist (Houston, TX)
- …application of positive language principles + Knowledge of coding classification systems, DRG and APC systems, official coding guidelines and coding compliance + ... Knowledge of an electronic medical record and imaging systems + Working knowledge of medical terminology, anatomy and physiology + Proficiency with electronic encoder application + Extensive PC knowledge - must be able to work effectively in common office… more
- HCA Healthcare (San Antonio, TX)
- …of the denial/downgrade + Explanation of Benefits/Remittance Advice + Payer denial/ DRG downgrade letters + Complex NCD/LCD guidelines, CMS/AHCA policies and ... regulations + Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites + Escalates problem accounts/processes/trends and report… more
- CenterWell (Corpus Christi, TX)
- …and judgment. The Medical Coder confirms appropriate diagnosis related group ( DRG ) assignments. Analyzes, enters and manipulates database. Responds to or clarifies ... internal requests for medical information. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of… more
- Molina Healthcare (San Antonio, TX)
- …Universal Claims, Surgery, Anesthesia, high dollar complicated claims, COB and DRG /RCC pricing), and IPA. + 2 years supervisory/management experience with ... appeals/grievance and/or claims processing within a managed care setting. **Preferred Education** Bachelor's degree Previous Director experience. To all current Molina employees: If you are interested in applying for this position, please apply through the… more
- Sumitomo Pharma (Austin, TX)
- …Strong knowledge and experience with pharmaceutical data sources (ie, IQVIA, SHA, MMIT/ DRG formulary / market access data). + Excellent team player and collaborative ... skills. + Strong project management skills and managing external vendors/ deliverables within tight timelines. + Strategic partner to multiple cross-functional stakeholders. + Proven success in developing analyses with Business Intelligence tools and methods… more
- Molina Healthcare (Fort Worth, TX)
- …risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups ( DRG 's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), ... and other payment mechanisms. * Understanding of value-based risk arrangements + Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare + Ability to mine and manage information from large data… more
- Datavant (Austin, TX)
- …+ Uphold an overall 95% coding accuracy rate and a 95% accuracy rate for MS- DRG assignments + Maintain a minimum production of 1 chart per hour or site-specific ... productivity benchmarks + Foster professional communication with colleagues, management, and hospital staff, while addressing clinical and reimbursement issues + Occasionally travel for professional development or meetings, if required **What You Need to… more
- HCA Healthcare (Brownsville, TX)
- …remote/work from home!** **Schedule: Monday-Friday Day Shift** **Must have DRG Validation experience and Inpatient Coding experience** **Benefits** Parallon, offers ... a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include… more
- Texas Health Resources (Arlington, TX)
- …management of NCCI/OCE billing edits). Knowledgeable in APC and DRG methodologies and all regulatory/payer requirements associated with coding. Demonstrated ... knowledge of an ability to apply THR coding policies and procedures to record review process. Demonstrated time management and organizational skills. Demonstrated clear and concise oral and written communication skills. Demonstrated strong decision making and… more