- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the achievement of ... all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles and is responsible for facilitating appropriate length of… more
- Banner Health (TX)
- …Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group ... clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work… 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 ... understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations and action plans. + Translates… more
- Molina Healthcare (Dallas, TX)
- …understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations and action plans. + Translate ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- Banner Health (TX)
- …information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- Banner Health (TX)
- …information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- Banner Health (TX)
- …information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- Texas Health Resources (Arlington, TX)
- …healthcare setting **REQUIRED** or **Licenses and Certifications** CCS - Certified Coding Specialist Upon Hire **REQUIRED** or Other CIC - Certified Inpatient Coder ... that require ICD-10-CM/PCS code and MS-DRG assignment for proper billing complex ( Medicare , high dollars, long LOS and high CMI) inpatient records. . Abstracts… more
- Highmark Health (Austin, TX)
- …topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles ... system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare… more
- Cardinal Health (Austin, TX)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... claims, including appeals and denials, to ensure timely and accurate reimbursement . + Processes denials & rejections for re-submission (billing) in accordance… more