- Houston Methodist (Houston, TX)
- …is responsible for supporting accurate billing and coding compliance with Medicare and third-party payments and internal policies. Responsibilities for this position ... medical record. + Provides periodic status reports of risk-based audit outcomes. Provides education as appropriate regarding department specific practices.… more
- UTMB Health (Galveston, TX)
- …calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible ... for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report… more
- Providence (TX)
- …not simply valued - they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused, whole-person care built on ... training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer reporting,… more
- Highmark Health (Austin, TX)
- …risk activities, including but not limited to internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and ... of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of… more
- Centene Corporation (Austin, TX)
- …candidate will have:_** + **_Knowledge of dual contract requirements (eg, Medicare -Medicaid plans)_** + **_Experience managing external audits and communicating with ... clear, actionable feedback_** + **_Skilled in developing and maintaining audit reporting, including tracking volume, identifying risks, and analyzing trends_**… more
- 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
- Houston Methodist (Houston, TX)
- …requests for information. **SERVICE ESSENTIAL FUNCTIONS** + Prepares and submits the annual Medicare cost report for each HM hospital and assists in cost report ... amendments, audit , appeals and reopening process. + Independently prepares federal...and keeps up-to-date with government regulations (ie Centers for Medicare and Medicaid (CMS), Internal Revenue Service (IRS), Federal… more
- Molina Healthcare (San Antonio, TX)
- …and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are ... met * Evaluate results from audit activities to address barriers, gaps, opportunities for improvement,...to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of… more
- Banner Health (TX)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper… more
- Molina Healthcare (Fort Worth, TX)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more