- Houston Methodist (Houston, TX)
- …an educational liaison to clinical staff and revenue cycle staff as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical ... FUNCTIONS** + Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and… more
- HCA Healthcare (Dallas, TX)
- …structure that successfully supports performance with accountable care organizations, CMS programs, payer specific quality programs and other quality, payer , and ... LCSW Care Managers, Care Coordinators + Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure… more
- Grifols Shared Services North America, Inc (Temple, TX)
- …business review analytics that effectively measure, track, and quantify changes payer /brand business segment, and competitor business patterns + Monitor and analyze ... industry, payer and customer trends, competitor pricing, and market conditions;...Skills & Abilities:** + Deep understanding of the US payer and market access environment and reimbursement methodologies +… more
- Caris Life Sciences (Irving, TX)
- …of denied or underpaid claims. This role requires a strong understanding of payer guidelines, excellent analytical skills, and the ability to lead a team in ... with internal teams to implement corrective actions. + Ensure compliance with payer -specific guidelines and regulatory requirements. + Analyze denial trends and root… more
- Cardinal Health (Austin, TX)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... a timely manner + Mediate effective resolution for complex payer /pharmacy issues toward a positive outcome to de-escalate +...appropriate sections of the database + Must track any payer /plan issues and report any changes, updates, or trends… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …and coding standards, seeking guidance from supervisor as necessary. Research payer policies to accurately and completely address billing compliance questions. ... relevant information to supervisor. Network with peers. + Monitors and addresses payer audits reviews. Establish process to obtain copies of government initiated… more
- KPH Healthcare Services, Inc. (Longview, TX)
- …records of all collection activities, including communication with payers and patients. + Payer projects as assigned. + Identify and report trends in claim denials ... Wellsky, and CareTend, etc.) + Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures. + Deep understanding of home… more
- HCA Healthcare (Round Rock, TX)
- …CCU and company coding policies, and monitor governmental and commercial payer information for complete, accurate and consistent code assignments. The CQR ... + Inform CQR Leadership of any significant issues (eg, education process issues, payer issues, vendor issues, etc.). + Stay informed and relay any unique coding… more
- Houston Methodist (Houston, TX)
- …and PCI compliance regulations. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Reviews third party payer work queues for complex payers and resolve accounts. + Manages ... payers and patients. This includes making outbound calls to payers and accessing payer websites. + Reviews and assesses entire account to determine necessary steps… more
- Moore County Hospital District (Dumas, TX)
- …acts for physical therapy, occupational therapy, speech therapy, regulatory agencies, payer guidelines, and policies and procedures of the department is maintained ... department as legislated by the State of Texas. Compliance with regulatory agencies, payer guidelines, and the policies and procedures of MCHD and the department is… more