- Danaher Corporation (Dallas, TX)
- …of national, regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through internal meetings, payer research, and ... diagnostics (preferred) + Demonstrated knowledge of all payer segments (eg Commercial, Medicare , Medicaid) + Demonstrated and presentation skills It would be a plus… more
- HCA Healthcare (Webster, TX)
- …with the patient, including having the Patient Choice letter signed. Monitors Medicare patient's planned discharge dates and delivers the Important Medicare ... encourage you to apply for our Case Management Assist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a… more
- HCA Healthcare (San Antonio, TX)
- …of the organization and meets the requirements or regulations of JACHO, Medicare , Medicaid, and appropriate licensing or certified boards. The supervisor is ... conditions of participation, requirements or regulations of the following: JCAHO, Medicare , Medicaid, Texas State Licensures, and Certification as required. 5. Makes… more
- CenterWell (League City, TX)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and...documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and… more
- Molina Healthcare (TX)
- …care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU ... The position also entails producing audit reports for internal and external review . The position may also work with other internal departments, including Compliance,… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient ... approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital… more
- Methodist Health System (Dallas, TX)
- …on continuous improvement of processes in identified risk areas. + Provide input, review and approve entity level annual compliance work plans. + Carry out the ... with the CLO/CCO and attorneys in the Office of Legal Affairs on any review or investigation that is non-routine and/or appears to create risk for MHS. +… more
- Fresenius Medical Center (Dallas, TX)
- …the designated clinical application accurately and in a timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... appointments + Weigh patient and obtain vital signs + Collect treatment records and review for completion. Notify RN of incomplete / missing records. + Cleaning and… more
- Methodist Health System (Dallas, TX)
- …hardware. * Proficiency with Microsoft Office in the Windows environment: ability to review and draft correspondence in email system and Microsoft Word; ability to ... use Microsoft Excel to review , organize and edit data. * Ability to use...primary care physician, physician specialties, Accountable Care Organization (ACO), Medicare , Medicaid, etc. **Behavioral Competencies** * Approaches problems with… more
- Glenview Wellness and Rehabilitation Center (North Richland Hills, TX)
- …Nursing Facility preferred. * Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. * Thorough understanding ... of the MDS with information obtained via medical record review as well as observation and interview with facility...management of the daily stand up meeting, to include review of resident care and the setting of the… more