- Community Hospital Corporation (Plano, TX)
- …month end reporting to CHC has been loaded. Analyze contractuals monthly and review trends, identify issues causing changes and or discrepancies, etc. + Oversee / ... daily cash receipts analyzing discrepancies. Reviews all balance sheet reconciliations and completes the review of the Post Closing Review Guide by the 25th of… more
- 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
- Houston Methodist (Houston, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... discharge planning, progression of care, documentation of improvement, and Medicare Conditions of Participation. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Ensures a… 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
- Evolent (Austin, TX)
- …provider and vendor contracting, compliance, population health (including utilization management), Medicare , and Medicaid. + Draft, review and negotiate ... President, Deputy General Counsel, the Attorney will prepare and review a variety of complex contracts and provide legal...of legal terms to promote efficiency. + Draft and review significant correspondence and other documents on behalf of… 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
- Methodist Health System (Dallas, TX)
- …claims, and billing correspondence. Knowledgeable with payors; Managed Care, Commercial, Medicare , and Medicaid Strong leadership skills with experience in team ... building, coaching, and mentoring. Excellent communication, problem-solving, and analytical skills. Ability to work in a fast-paced environment and manage multiple priorities. Proficiency in healthcare billing software, systems and payer portals (eg, Epic,… more
- Humana (Austin, TX)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CenterWell (Fort Worth, TX)
- …experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in care, ensuring clinical ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals *Personally… more