- Houston Methodist (The Woodlands, TX)
- …resources to initiate and verify authorization needed for prompt submission. Notifies the payer of the patient's admission or procedure in a timely manner, to ensure ... volume + Ability to review clinical documentation for Medical Necessity and payer requirements + Working knowledge of CPT, International Classification of Diseases… more
- Baylor Scott & White Health (Dallas, TX)
- …charges, ensuring that services are compliant with federal, state, private payer , and other applicable legal and regulatory requirements. He/she is responsible ... charge edits to validate the accuracy of information and compliance with payer requirements. Exercise independent judgment in best practice for charging edit… more
- Elevance Health (Grand Prairie, TX)
- …that audits meet the industry's best practices and payer -specific requirements. .Collaborates cross-functionally with clinical, compliance, provider engagement, ... knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology… more
- United Therapeutics (TX)
- …center / HUB services, market access, and/or other matrix field partners. Serve as the payer expert for a defined geography and communicate payer changes to key ... stakeholders in a timely manner. + Ensure understanding of the reimbursement process, specialty pharmacies, field reimbursement services, and UT's patient support program. Advise on patient level reimbursement issues in compliance with policies and… more
- Evolent (Austin, TX)
- …in a services-oriented organization. + Strong demonstrated understanding of provider, and payer personas, 'jobs to be done' and practice workflows, with a preference ... with scrum and agile methodologies. + Proven experience working closely with Payer customers is required. + Experience with Lean/Six Sigma or other process… more
- Walgreens (Dallas, TX)
- …pharmacy department employees are trained in all required functions regarding payer and pharmaceutical contractual requirements (adverse event reporting, data and ... pharmacy department employees are trained on all required functions regarding payer and pharmaceutical contractual requirements (Adverse event reporting, data and… more
- Oracle (Austin, TX)
- …delivery through powerful, AI-driven workflow innovation. Our Autonomous Reimbursement, Payer , and Interoperability teams are developing advanced solutions to ... technical program management efforts across mission-critical projects in RevenueCycle, Payer , and Interoperability domains. + Design, implement, and continuously… more
- Houston Methodist (Houston, TX)
- …or methods to best fit the patient's situation + Knowledge of payer requirements, authorizations, and insurance terminology + Proficient understanding of medical ... computer skills and ability to learn and navigate multiple software programs and payer websites + Ability to handle detail work accurately and rapidly + Working… more
- Houston Methodist (Katy, TX)
- …a variety of audits including RAC, MAC, CERT, PERM, TPE, and commercial payer audits. + Oversee case intake, documentation collection, quality review, and timely ... Quality Assurance** + Ensure all audit activity complies with CMS, commercial payer , and regulatory requirements. + Support policy and process development to… more
- Cardinal Health (Austin, TX)
- …with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures. ... subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of… more
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