- Insight Global (Plano, TX)
- …and other coding factors. Apply current clinical criteria including MCG, InterQual, payer clinical policy bulletins, CMS guidelines, NCDs, and LCDs. Adhere to coding ... guidelines and Clinical Documentation Improvement (CDI) best practices as endorsed by ACDIS and AHIMA. Compose and send queries when documentation is insufficient or unclear. Identify query opportunities and ensure accurate code assignment and sequencing.… more
- Highmark Health (Austin, TX)
- …both the return on investment (ROI) and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this ... team is responsible for identifying those gaps, building requirements to drive the development of new capabilities, and tying them to Highmark's strategic capability roadmap. They will need to work effectively across teams to inform and influence change to… more
- UTMB Health (Galveston, TX)
- …departmental leadership on productivity metrics, revenue cycle performance, and payer contracting * Establish divisional governance structure including clinical ... operations, research, and fellowship program committees to ensure transparent decision-making and faculty engagement * Participate in departmental strategic planning, faculty recruitment, and institutional committees as assigned, representing infectious… more
- UTMB Health (Galveston, TX)
- …and work with departmental leadership on revenue cycle performance and payer contracting * Participate in departmental strategic planning, faculty recruitment, and ... institutional committees as assigned * Collaborate with nursing leadership, pharmacy, infusion services, and allied health professionals to ensure high-quality, team-based care delivery including management of biologic therapies and immunosuppressive agents *… more
- Highmark Health (Austin, TX)
- …and control frameworks, and assessment methodologies, particularly as applied to healthcare ( payer and provider) business processes. + Knowledge of how to leverage ... technologies to drive efficient and effective GRC processes across payor/provider industries. + Experienced with resource and project planning capabilities, decision making skills, history of results-oriented delivery, and participation in team building across… more
- R1 RCM (Austin, TX)
- …of the top 100 US health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare ... organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com . more
- HCA Healthcare (Live Oak, TX)
- …thorough working knowledge of the rules of Medicare, Medicaid, and private payer regulations and processes. You will possess a thorough understanding of managed-care ... concepts and length-of-stay management relating to patient and organizational fiscal responsibility. + You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or psychosocial needs. + You… more
- UTMB Health (Galveston, TX)
- …independently for professional services rendered, in accordance with UTMB and payer guidelines. + Participate in quality improvement initiatives, clinical research ... (as applicable), and educational activities within the EP subsection. **Salary Range:** Commensurate with experience. **JOB SUMMARY** Performs responsible clinical care in collaboration with the unit physician and under approved protocols, manages the medical… more
- Option Care Health (Austin, TX)
- …geographies + Advanced understanding of IG to include clinical, market, and payer dynamics + Knowledge of reimbursement, managed care, and marketing **Basic ... Qualifications** + Proven record of accomplishments in the home infusion market in IG and SCIG across multiple geographies + Proficient in territory analysis and planning + Results-oriented mindset with expertise in the complete selling cycle (call objectives,… more
- Texas Health Resources (Arlington, TX)
- …CPT, HCPCS) of professional charges in compliance with third party payer , NCCI guidelines and THPG policies. Maintains documentation to record/track coding ... variance. * Performs charge reconciliation. * Performs charge reconciliation of facility charges posted against OR/scheduled procedures to identify missed charges. Notifies leadership regarding discrepancies, collaborates with practice staff and providers to… more