- Evolent (Austin, TX)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve ... as the Physician match reviewer in Imaging cases, that do not...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Abbott (Plano, TX)
- …experience + General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . ... Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Experience in medical device or DME Billing a plus +… more
- Houston Methodist (Houston, TX)
- …expert for management and operations staff of specific HM facility and Physician Organization contracts for reimbursement of services billed through managed care. ... managed care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral… more
- STG International (Temple, TX)
- …8. Identify resident problems and emergency situation and initiate emergency care per physician 's orders in the absence of a physician 9. Provide supervision ... meetings, in-service classes and committee meetings as assigned 11. Review the Glucometer Control Log to monitor the machine...assigned as per your licensure. Report untoward findings to physician and your supervisor 18. Observe the 5 RIGHTS… more
- HCA Healthcare (Plano, TX)
- …and facility processes. . Prepares documentation for Notification of Non-covered Medicare Services or Advance Beneficiary notices to patients and follows practice ... medical record or practice management system. . Collects necessary and appropriate physician and practice fees associated with the procedure. . Verifies/confirms … more
- Houston Methodist (The Woodlands, TX)
- …Seeks management assistance appropriately. + Contributes to patient, employee, and physician satisfaction. Proactively presents solutions to resolve access to care ... as needed utilizing clinical information provided by the ordering physician . Monitors and tracks authorizations, including ensuring accurate Current Procedural… more
- HCA Healthcare (Pasadena, TX)
- …certification of individuals. They must also ensure the facility and/or physician performing the services have met the special certification, accreditation ... are high. **What you will do in this role:** + Coordinate NCD/LCD/LCA review process at the Division level + Determine whether new/revised NCDs/LCDs/LCAs apply to… more
- Fresenius Medical Center (Olmito, TX)
- …+ Ensure effective communication with patients, dialysis clinics, hospitals and physician (s), to address any concerns/ issues Facility Operations + Participate in ... state regulations, and accrediting agency standards where applicable. + Participate in review business and finances of the site, including financial reports, market… more
- Banner Health (TX)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... and ethical coding compliance. If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient's… more
- Evolent (Austin, TX)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as, aids and acts as ... the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more