- HCA Healthcare (Pasadena, TX)
- …+ You will maintain a thorough working knowledge of the rules of Medicare , Medicaid, and private payer regulations and processes. You will possess a thorough ... encourage you to apply for our Social Worker MSW opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock… more
- Sedgwick (Austin, TX)
- …filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and ... deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business + Excellent… more
- Prime Healthcare (Dallas, TX)
- …Fraud, Waste and Abuse laws and regulations, along with the Medicare /Medicaid Conditions of Participation, physician/physician group contracting, Medical Staff/peer ... review matters, hospital/facility licensing, telemedicine, Ambulatory Surgical Centers, and other healthcare operations5. Excellent contract negotiation and drafting… more
- Houston Methodist (Houston, TX)
- …knowledge of electronic health record software (EPIC preferred) + Knowledge of Medicare , Medicaid, and managed care reimbursement methodologies + Ability to manage ... to meet needs related to unanticipated patient volume + Ability to review clinical documentation for Medical Necessity and payer requirements + Working knowledge… more
- Evolent (Austin, TX)
- …quality.** + **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary actions by ... **state or federal healthcare programs ( Medicare , Medicaid, OIG, or GSA).** Join us at **Evolent Health** and be part of a team that is transforming healthcare… more
- Houston Methodist (Houston, TX)
- …Office (CBO). This includes, but is not limited to, resolution of charge review (where applicable) and claim edits, payor rejections, unresolved or no response ... processing. + Demonstrates understanding of fundamentals of all payors, including Medicare , Medicaid and commercial payors, and applicable revenue cycle operations.… more
- Houston Methodist (Houston, TX)
- …is responsible for supporting accurate billing and coding compliance with Medicare and third-party payments and internal policies. Responsibilities for this position ... **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates… more