- Elara Caring (Dallas, TX)
- …hospice, and behavioral health agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations. The Auditor's areas of focus to ensure quality ... clinical, and operational information You will report to the Director of Quality Audit and Education. _This is not a comprehensive list of all job_ responsibilities… more
- Molina Healthcare (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
- HCA Healthcare (Austin, TX)
- …+ Ensuring compliance with federal, state and HCA regulations, policies, procedures, and audit requirements in the use of patient data for research purposes + ... + Experience with large health care data sets including, electronic health records, Medicare claims, or other health care claims data sets preferred. + SAS, R,… more
- Caris Life Sciences (Irving, TX)
- …and counseling that may be required due to the results of the audit ; including, providing recommendations, guidance, and implementing solutions to improve results. + ... + Expert in Business-to-Business (B2B) communications. + Advance knowledge of Medicare , Medicaid and commercial insurance guidelines, and medical billing processes +… 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
- Baylor Scott & White Health (Temple, TX)
- …for the activity as assigned. + Maintains mailing process tracking of the Medicare mailed correspondence. Assures letters are delivered to the mailroom in timely ... fashion. + Assists with audit preparation as needed by management. **KEY SUCCESS FACTORS** + Requires current knowledge of all regulatory requirements as they apply… 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
- HCA Healthcare (Pasadena, TX)
- …clinical documentation, making necessary corrections in Patient Accounting. Based on audit findings, present recommendations to Corporate and SSC Revenue Integrity ... calls, ensuring continuous education. + Possess working knowledge of Medicare guidance, inpatient/outpatient status, and observation requirements. + Knowledge of… more
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