- Datavant (Austin, TX)
- …vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code diagnoses using a standardized system, ensuring ... + Proficient in ICD-10 coding. + Experienced in HCC coding across Medicare , commercial, and Medicaid sectors. + In-depth knowledge of medical terminology,… more
- STG International (Temple, TX)
- …and care needs. Follow and educate community team members on the review process and provide recommendations to address potential areas of concern/opportunity, ... X2 to obtain a 6 day look back and review for anything that flags impacting care plans and...to exceed thirty days. Familiar with Reimbursement system of Medicare , Medicaid & Case Management Preferred Skilled Nursing Facility… more
- Molina Healthcare (Dallas, TX)
- …requirements * Meet with Production Manager and business owners as needed to review and understand details of print and fulfillment business requirements for various ... resolution * Input and manage projects into company procurement database * Review , reconcile, route and submit all invoices for payment and maintain reporting… more
- Cardinal Health (Austin, TX)
- …data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company. ... facility fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines;...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- WTW (Dallas, TX)
- …as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims, resolve open ... Clearly communicate and professionally interact with vendor and audit team + Review documentation of potential discrepancies for thoroughness and accuracy + Resolve… more
- Humana (Austin, TX)
- …for chart reviews for the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to engage providers and members to ... (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization… more
- CenterWell (Austin, TX)
- …phone call related include but are not limited to: + Pharmacist Care Plan/Treatment Review + Review prescriptions for accuracy + Check for drug-drug interactions ... + Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care… more
- Prime Therapeutics (Austin, TX)
- …based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal partners. ... + Ability to collaborate and work well as a team. + Data review and interpretation skills required. **Preferred Qualifications** + Managed care experience (Health… more
- Molina Healthcare (San Antonio, TX)
- …Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Molina Healthcare (Fort Worth, TX)
- …HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
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