- Humana (Austin, TX)
- …about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and ... validate the mitigation of compliance risk across the organization. This team ensures that...revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and… more
- Highmark Health (Austin, TX)
- …with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts ... system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare… more
- Molina Healthcare (San Antonio, TX)
- …Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations ... and guidelines of risk adjustment data * Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy * Identify opportunities for data mining to ensure data gaps are minimized * Apply… more
- Highmark Health (Austin, TX)
- …This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within ... responsible for the administration, interpretation, and enforcement of the Compliance Program including auditing/monitoring operational processes, conducting or overseeing… more
- Molina Healthcare (El Paso, TX)
- …+ Nursing License (RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested ... quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality… more
- Houston Methodist (Houston, TX)
- …programs; works across the system to assess, measure, and report compliance with standards; and develops, implements and evaluates strategies to promote ... of evidence-based best practices and standardization to enhance system-wide compliance . **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates and effectively communicates… more