- Ensono (Houston, TX)
- …US Citizenship and pass related background checks including but not limited to Medicare and Medicaid and VA **Preferred Skills:** + Experience with secure file ... transfer protocols and audit /compliance requirements. + Ability to work in a hybrid...a strong background in implementing and maintaining Centers for Medicare & Medicaid Services (CMS) security standards and compliance… more
- Houston Methodist (Sugar Land, TX)
- …issues or concern that may require clinical review during the pre-bill, audit , or appeal process. + Secures reimbursement for hospital services by communicating ... of local and national coverage determinations + Comprehensive knowledge of Medicare , Medicaid, and Managed Care requirements + Comprehensive knowledge of community… more
- Houston Methodist (Houston, 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
- 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
- Molina Healthcare (Houston, TX)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… 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
- CVS Health (Austin, TX)
- …with heart, each and every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...International Classification of Disease (ICD) codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- Prime Therapeutics (Austin, TX)
- …reporting to the Corporate Compliance Committee (CCC) and Finance, Compliance & Audit Committee (FCA) meeting materials. + Act as a liaison between technical ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- Abbott (Plano, TX)
- …+ Timely follow up for requested authorizations. + For each procedure, audit required clinical documents for completeness and accuracy. + Obtain authorization for ... + General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review. Some… more
- Aveanna Healthcare (Dallas, TX)
- …communication standards within the office. + Payroll Assistance: Review weekly timesheets, audit payroll files, and serve as the primary contact for caregiver ... skills are a PLUS. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with...Aveanna's supportive and dynamic environment! As an employer accepting Medicare and Medicaid funds, employees must comply with all… more