- 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
- Humana (Austin, TX)
- …+ Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure + ... Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and… more
- Centene Corporation (Austin, TX)
- …and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective ... and actual CMS and other regulatory audits and coordinates with Internal Audit , Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency… more
- Molina Healthcare (San Antonio, TX)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management… more
- Fresenius Medical Center (Cypress, TX)
- …as directed. + Participates in medical records, infection control, and other audit processes as directed. + Actively collaborates with others during staff huddles ... diploma or GED required. + Must meet Centers for Medicaid and Medicare Services (CMS)-approved state and/or national certification requirements within the required… more
- HCA Healthcare (Round Rock, TX)
- …communicate nuances of unique coding requirements for major payers such as Medicare , Medicaid, HMO's, PPO's, IPA's, employers, etc. + Demonstrate and share knowledge ... preferred. + Inpatient/outpatient professional fee coding experience required. + Previous audit experience preferred. + Coding certification through AHIMA or AAPC… more
- Humana (Austin, TX)
- …+ Familiarity with compliance standards, Finance data governance, and system audit -readiness. **Preferred Qualifications** + MBA or other Advanced Degree + ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Austin, TX)
- …+ Familiarity with compliance standards, HR data governance, and system audit -readiness. **Preferred Qualifications** + MBA or other Advanced Degree + Demonstrated ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Community Hospital Corporation (Plano, TX)
- …+ Coordinates and manages all aspects of all audits including the annual financial audit . + Pulls all data to prepare and assist with annual cost reports and ... parties including but not limited to Uncompensated Care, Disproportionate Share ( Medicare and Medicaid), American Hospital Association (and state) annual reporting.… more
- Houston Methodist (Houston, TX)
- …Compliance and other committees as required. Works collaboratively with the Internal Audit and Business Practices to respond to deficiencies and to strengthen ... analyses, etc. - Performs detailed claims testing and medical review. - Reviews Medicare Coverage Analysis to ensure completion prior to handing off to review by… more