- Houston Methodist (Houston, TX)
- …study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review . - Reviews Medicare Coverage Analysis to ensure completion prior to ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- CenterWell (Eastland, 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
- Houston Methodist (Houston, TX)
- …packaging and labeling of organs for transplantation; facilitating organ offer review and acceptance processes, recipient admission and pre-operative preparation for ... in organ recovery process according to transplant center protocol. Ensures proper review of donor verifications (surgical time-out) prior to recovery with recovery… more
- Houston Methodist (Baytown, TX)
- …with hospital leadership, establishes a process to conduct a proactive review of regulatory, accreditation and certification to assess vulnerabilities to compliance ... to hospital leadership. Provides support and guidance for survey follow-up including review and feedback related to corrective action plans. + Provides education and… 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
- 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
- Fresenius Medical Center (Fort Worth, TX)
- …the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... or state specific certification as defined by Center for Medicaid/ Medicare (CMS)Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated commitment to organization culture,… more
- Elevance Health (Houston, TX)
- …full accurate and appropriate diagnosis, documentation, coding and care. will review all provider visit medical encounters and apply most appropriate diagnosis ... + Liaison to coding team. + Participate in peer review of medical documentation for completed visit notes and...3 years' experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model** ;… 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
- Molina Healthcare (Houston, 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 ... also entails producing audit reports for internal and external review . The position may also work with other internal...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more