- Molina Healthcare (Dallas, TX)
- …provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, ... including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate complex business problems… more
- HCA Healthcare (Corpus Christi, TX)
- …as an educational resource to patients, families, interdisciplinary team members, payer representatives, and other parties as appropriate about behavioral services. ... + Reviews, coaches, and helps with the training of new staff/interns as assigned within approved practice and program guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with… more
- Amgen (Houston, TX)
- …Services, MSLs, Nurse Educators, TLLs, Field Reimbursement]. + Strong knowledge of payer policies, reimbursement processes, and managed markets is a plus; experience ... negotiating access or navigating formulary pathways is preferred for more strategic roles. + Proven ability to build strong customer relationships, educate on complex disease states, and adapt communication to diverse audiences. + Excellent interpersonal,… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …applicable licenses, controlled substance registrations, hospital privileges, and third payer enrollments in good standing + Supervises residents, and participates ... in teaching activities for medical students and/or residents + Engages in research and/or scholarly activities to advance clinical practice + Serves the academic community through participation in institutional governance, such as committee work and… more
- Sharecare (Austin, TX)
- …Summary:** CareLinx is looking for a Care Advisor to assist with CareLinx's Payer Operations line of business. CareLinx is a healthcare technology platform that ... connects families with non-medical, in-home caregivers, and Care Advisors provide support and guidance to families during the caregiver search, interview, and hire process. Once a caregiver match is made, the Care Advisor will follow closely to ensure… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …+ Strong understanding of the US & Global healthcare landscape, including payer and policy environments + Excellent communication, leadership, and project management ... skills + Strong understanding of pharmaceutical compliance and regulatory frameworks + Excellent communication and interpersonal skills, with the ability to influence cross-functional teams + Strong analytical and problem-solving skills to address complex… more
- Datavant (Austin, TX)
- …to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. + Demonstrate understanding of complications, co-morbidities, severity of ... illness, risk of mortality, case mix index, secondary diagnoses, and procedure impact on DRG. + Improve coding specificity by educating physicians and caregivers on the importance of clear documentation throughout a patient's stay. + Follow AHA guidelines and… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …required but a plus: Certified Professional Coder (CPC), CPC-Hospital, CPC- Payer , Certified Interventional Radiology Cardiovascular Coder (CIRCC) and Certified ... Professional Medical Auditor (CPMA) + Experience: A minimum of 1 year coding experience required preferably with psychiatric services + Knowledge, Skills & Abilities: + Knowledge of medical terminology; basic and advanced ICD-9-CM coding; anatomy and… more
- US Anesthesia Partners (Dallas, TX)
- …due to practice diversity and our maintenance of several exclusive facility contracts. Our payer mix and income are therefore very favorable. We have been engaged in ... leadership in USAP and predecessor organizations since inception. Further, we have great working relationships and operational/financial integration with many surrounding USAP divisions. We are seeking physicians to be on a Partnership Track. This Track works… more
- Erickson Living (Dallas, TX)
- …the community continuum of care. + Following Federal, State, and all Payer guidelines, ASHA requirements, and company policies and procedures. Ensuring departmental ... understanding and compliance in the areas of care provision, documentation, billing reimbursement, resident rights, customer service, and compliance. + Providing a holistic approach, supporting the residents' physical, spiritual, emotional, and clinical needs… more