- Elevance Health (Houston, TX)
- …or quality assurance environment preferred. + Broad, deep and niche knowledge of medical claims billing /payment systems provider billing guidelines, payer ... considered._ The DRG Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG)… more
- University of Texas Rio Grande Valley (Harlingen, TX)
- …service rendered to patients. * Conducts complex reviews of physician/provider billing compliance activities in accordance with applicable laws, regulations, rules ... retrospective audits of documentation to confirm compliance with documentation and billing rules and government regulations. Provides feedback and education related… more
- Molina Healthcare (Fort Worth, TX)
- …working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing /payment systems provider billing guidelines, payer ... and implementation of the DRG validation program. Responsible for auditing inpatient medical records and generating high quality claims payment to ensure payment… more
- BAYADA Home Health Care (Austin, TX)
- …the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct ... it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
- BAYADA Home Health Care (Austin, TX)
- …the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct ... it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
- Houston Methodist (Houston, TX)
- …denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations. **SERVICE ESSENTIAL FUNCTIONS** + ... are needed. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Analyzes data from various sources ( medical records, claims data, payer medical policies, etc.), determines… more
- Houston Methodist (Houston, TX)
- …Methodist facilities. The Director manages personnel performing inpatient and outpatient medical record coding, DRG and APC assignment, abstracting, and data entry ... functions; ensures accuracy and quality of coded and abstracted medical record data. This position coordinates coding and abstracting activities; provides data… more
- Elevance Health (Grand Prairie, TX)
- …identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse ... control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare...in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years… more
- Texas Health Resources (Arlington, TX)
- …- Certified Coding Specialist 12 months **REQUIRED** COC (Certified Outpatient Coder ) 12 months **REQUIRED** **Skills** Proficient in software applications (Excel, ... CPT-4. Expert in coding convention/automated encoder (knowledge management of NCCI/OCE billing edits). Knowledgeable in APC and DRG methodologies and all… more