- Highmark Health (Austin, TX)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- CenterWell (Austin, TX)
- …at the division and market level; Partners with Clinical Documentation Improvement, Audit , and Education to develop programs to improve clinical documentation. + ... development and compliance with coding standards. + Partner with analytics and audit to identify coder errors and develop plans to address deficiencies/specific… more
- Humana (Austin, TX)
- …Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This ... action plans, as needed. You will participate in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with… more
- Prime Therapeutics (Austin, TX)
- …internal and external distribution Compliance Committee and the Compliance and Audit Committee and supports the Chief Compliance Officer's compliance governance ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** +… more
- Houston Methodist (The Woodlands, TX)
- …or concerns that may require clinical review during the pre-bill, audit , or appeal process. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies and presents ... or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care requirements + Progressive knowledge of community… more
- Zelis (TX)
- …through our modeling systems, validating pricing accuracy across Medicare , Medicaid, and commercial reimbursement methodologies, and supporting client-facing ... SQL queries (joins, CTEs, subqueries) to extract, manipulate, and audit claim data. + Evaluate pricing scenarios based on... claim data. + Evaluate pricing scenarios based on Medicare , Medicaid, and commercial reimbursement rules. + Apply working… more
- Texas Health Resources (Dallas, TX)
- …requirements and THPG standards. Coordinate external audits such as recovery audit contractors for governmental agencies and/or commercial payer audits. Analyze ... of and comply with federal and state laws and regulations including Medicare /Medicaid program requirements. Lead and/or work with appropriate resources to ensure… more
- Elara Caring (Dallas, TX)
- …Personal Care Services (PCS) agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations and billing rules. Areas of focus for audits will ... with internal policies and procedures and the annual compliance audit work plan; (2) ensuring accuracy of such audits;...audits; (3) providing education to agency personnel based on audit results; (4) assisting agencies with corrective action plan… more
- Humana (Austin, TX)
- …to determine issues and improvements + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required ... + Research and analyze compliance information necessary to support internal and external audit activity. + Act as "Go To" person for resolution of issues relating… more
- Evolent (Austin, TX)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more