- Houston Methodist (Katy, TX)
- …Fry Rd. Katy, TX 77450** **. (Hybrid position)** At Houston Methodist, the CBO Regulatory Compliance Specialist position is responsible for working with ... Medicare compliance experience is preferred** **Note:...Center for Medicare /Medicaid Services (CMS), other applicable regulatory agencies, and/or Houston Methodist Internal Audit compliance… more
- Aveanna (Houston, TX)
- …Category: Compliance Salary: $90,000 per year Position Details Position Overview The Regulatory Compliance and Coverage Specialist will report to the ... Regulatory Compliance and Quality Review. The Regulatory Compliance and Coverage Specialist ...RN + Thorough knowledge of the home care industry, Medicare and Medicaid coverage requirements, clinical and operations practices,… more
- Houston Methodist (Sugar Land, TX)
- …among departments and disciplines to achieve and sustain ongoing accreditation and regulatory compliance . + In partnership with hospital leadership, establishes ... of regulatory , accreditation and certification to assess vulnerabilities to compliance with standards. + Collaborates with hospital leadership to assign teams to… more
- Baylor Scott & White Health (Temple, TX)
- …on member issues, as needed. **KEY SUCCESS FACTORS** + Sales and regulatory experience in Medicare Advantage, Marketplace, and Commercial insurance. + ... **JOB SUMMARY** The Sales Training Specialist is responsible for developing and implementing an...Texas Department of Insurance (TDI) and the Center for Medicare and Medicaid Services (CMS) regulations; maintains training log… more
- Evolent Health (Austin, TX)
- …Will Be Doing:** + Develops and customizes correspondence according to regulatory requirements and contractual requirements including coordinating Compliance ... to providing better health outcomes._ **Collaboration Opportunities:** A Correspondence Policy Specialist on the Shared Services Correspondence team will be working… more
- Highmark Health (Austin, TX)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- Apex Health Solutions (Houston, TX)
- Summary The Commercial Health Plan Enrollment Specialist is responsible for maintenance of eligibility data, resolving all issues or requests regarding eligibility, ... procedures according to current business needs as well as industry and regulatory requirements; assists management with the preparation of training materials and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... responsible for the timely coordination and completion of regulatory and/or revenue-enhancing special projects as identified by the Revenue Cycle Managers. In… more
- Texas Health Resources (Denton, TX)
- …rendered. . **Educates patients and/or families** about applicable legal, ethical, and compliance documents; ensures regulatory consents are signed by the ... Admissions Specialist I _We're looking for qualified_ **_Admissions ...are completed correctly, particularly the MSPQ, Important Message from Medicare (IMM) and medical necessity checking (ABN and Letter… more
- Gentiva (Dallas, TX)
- …guidelines. + Knowledge of hospice operations, state and federal regulations and compliance + Strong regulatory affairs and governance requirements for ... day. **Overview** We are looking for an **Executive Director Specialist RN** . You will serve as the administrator...maintain standards of high quality and customer service in compliance with federal and state regulations and guidelines. +… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …modifiers and procedure codes for physician/provider services consistent with coding compliance policies, ICD-10-CM Official Coding Guidelines and regulatory ... **37378BR** **Extended Job Title:** Coding Specialist (Medical Coding/Alberta) **Org Level 1:** Texas Tech...and/or academic health sciences/medical center + Strong overview of Medicare and Medicaid billing compliance + Completion… more
- Texas Health Resources (Stephenville, TX)
- …rendered 10% Educates patients and/or families about applicable legal, ethical, and compliance documents; ensures regulatory consents are signed by the ... **Admissions Specialist - PRN** **_We're looking for a qualified...are completed correctly, particularly the MSPQ, Important Message from Medicare (IMM) and medical necessity checking (ABN and Letter… more
- Texas Health Resources (Bedford, TX)
- …rendered. . **Educates patients and/or families** about applicable legal, ethical, and compliance documents; ensures regulatory consents are signed by the ... **Admissions Specialist I** _We're looking for qualified_ **_Admissions Specialist_**...are completed correctly, particularly the MSPQ, Important Message from Medicare (IMM) and medical necessity checking (ABN and Letter… more
- CVS Health (Austin, TX)
- …of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and ... Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range...+ CRC, CDMS, CRRN, COHN, or CCM certification + Medicare and Medicaid experience + Managed care experience +… more
- Banner Health (TX)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG), and Ambulatory Payment Classification (APC) or ... coding is accurate for proper reimbursement and that coding compliance is complete. Monitors coding work and trends, then...assessments. 6. Maintains a current knowledge in all coding regulatory updates, and in all software used for coding… more
- The Cigna Group (Houston, TX)
- **Job Summary:** This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment & Stars program for assigned populations in an operational ... subject matter expertise to assigned providers and internal matrix partners of Cigna Medicare 's programs specific to CMS Risk Adjustment and HCC Coding Processes. It… more
- Conviva (Corpus Christi, TX)
- …departmental and physician budgets. + Assess, develop, and recommend strategies for compliance with regulatory requirements. + Develop and maintain an effective ... + 99% Leadership, 1% limited/occasional coverage + Build strong relationship with specialist , hospitalist, SNF and other providers to form a narrow network of… more
- MD Anderson Cancer Center (Houston, TX)
- …with the Standards of Ethical Coding set forth by the AHIMA/AAPC/AHA/AMA and the regulatory agencies CMS/WHO and uphold HIPAA compliance rules and regulations * ... and evaluating the quality of coded data while maintaining institutional, compliance and departmental policies in accordance with the rules and regulations… more
- Molina Healthcare (TX)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, ... appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN)… more