Physician ED Claims Reviewer VytwoPhysician ED Claims ReviewerDallas, TXRemoteFull timeRequired skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity. Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered.
Director of Clinical Reimbursement & Revenue Optimization Buckner InternationalDirector of Clinical Reimbursement & Revenue OptimizationDallas, TXEducation and Training Lead enterprise reimbursement education, talent development, and performance improvement initiatives by delivering training and coaching, establishing competency programs and succession pathways, developing reimbursement dashboards and KPI reporting, and driving data-informed operational improvements across the organization. Clinical Reimbursement Leadership Provide enterprise leadership for skilled nursing reimbursement programs by developing reimbursement strategies, ensuring compliance and revenue integrity, monitoring regulatory and payer changes, and serving as the primary reimbursement resource for BRS communities.
Palliative Care Nurse Practitioner- PPV CompassusPalliative Care Nurse Practitioner- PPVDallas, TXThe Nurse Practitioner, if providing hospice care, functions as an extension of the interdisciplinary team (IDT) and hospice physician to provide routine recertification and emergency assessments, educational, and evaluative services to meet the needs of patients and their families. If providing Hospice Face to Face Visits: Performs routine and emergency assessments: Completes routine and emergency recertification visits on each patient entering their 3rd benefit period or beyond (including admissions and transfers).
Director of Practice Operations- Women's AdventHealthDirector of Practice Operations- Women'sMansfield, TX$99,344–$184,769 / yearUnderstands capital responsibilities and core tenets of expense management and revenue impact from volume, identifying and developing capital needs for practices to assist in annual capital planning. Additional Information: An equivalent combination of education ad relevant work experience may be considered in lieu of the stated degree requirement: Bachelor's degree AND 5+ years of experience OR.
HIM CODER ANALYST II AA2ITHIM CODER ANALYST IIFort Worth, TX$35–$40 / hourReviews and interprets patient medical record documentation to identify pertinent diagnoses and procedures and assigns ICD-10-CM and CPT 4 codes accurately and timely to the highest level of specificity based upon physician documentation for ambulatory surgery, special procedure, observation, emergency department, outpatient ancillary and clinic visit records. Communicates with physicians and other providers regarding documentation requirements and collaborates with Clinical Documentation Specialists on patient cases regarding documentation needs and requirements, and coding assignment accuracy.
EPIC AA2ITEPICFort Worth, TX$35–$40 / hourReviews and interprets patient medical record documentation to identify pertinent diagnoses and procedures and assigns ICD-10-CM and CPT 4 codes accurately and timely to the highest level of specificity based upon physician documentation for ambulatory surgery, special procedure, observation, emergency department, outpatient ancillary and clinic visit records. Communicates with physicians and other providers regarding documentation requirements and collaborates with Clinical Documentation Specialists on patient cases regarding documentation needs and requirements, and coding assignment accuracy.
Medical Coder Presidential Staffing Solutions, LLCMedical CoderDallas, TXRemoteFull timeWe are seeking a Remote Medical Coder to join our team in support of the Captain James A. Lovell Federal Health Care Center . The ideal candidate is detail-oriented with strong people skills and computer skills.
Benefit Verification Specialist - DFW Urology Partners of North TexasBenefit Verification Specialist - DFWArlington, TXIn this dynamic position, you’ll handle essential day-to-day administrative functions such as patient registration, insurance verification, prior authorizations, and managing key tasks like scanning, faxing, and financial reconciliation of deductibles, copayments, and coinsurance. Accurately utilizes cost estimate technology to create cost estimates for services and communicates estimated costs to patients and other affected parties.
NewRating/Claims System Analyst Elevance Health IncRating/Claims System AnalystGrand Prairie, TX$65,680–$94,415 / yearThree or more years of experience leading end-to-end User Acceptance Testing (UAT), including: (Test strategy and planning, Test scenario and test case development, Test execution, Defect management and validation, Production readiness activities, Code editing and claims knowledge) preferred. How you will make an impact: Responsible for collaborating with cross-functional stakeholders, including business partners, Product Owners, developers, Quality Engineering teams, and vendors, to ensure solutions meet business and technical requirements.
Senior Manager, Corporate Compliance - Risk Adjustment CVS Health CorpSenior Manager, Corporate Compliance - Risk AdjustmentIrving, TX$75,400–$165,954 / yearThis position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements. As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements.
Principal Engineer-Software Development VerizonPrincipal Engineer-Software DevelopmentIrving, TexasYou will mentor technical teams and develop high-quality, robust applications that meet critical business needs within our evolving Customer Experience Platform (CXP) and FiOS Order management platform. In the role of Principal Engineer of Software Development, you will provide technical leadership for the design and implementation of complex, scalable software solutions primarily using Java Spring Boot and React.
NewClaims Examiner Sr Sigma IncClaims Examiner SrIrving, TXThis is an excellent opportunity for professionals with experience processing medical claims, Medicare, managed care, and healthcare reimbursement . Collaborate with Business Configuration, Appeals, Provider Data, Network Management, and other operational teams.
Inpatient Corporate Coder - Remote based in the US Tenet Healthcare CorpInpatient Corporate Coder - Remote based in the USDallas, TXRemote$26.40–$38 / hourThe CC is responsible for coding of Tenet facilities as assigned, assisting with productive coding to maintain DNFC, assisting with quality chart reviews, assisting with the training of new CC's and/or other projects where indicated. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need.
NewAR Specialist I Methodist Health SystemAR Specialist IDallas, TexasNamed one of the fastest-growing health systems in America by Modern Healthcare , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Also depending upon assigned role you may be responsible for reviewing claim information to ensure accuracy and provide feedback to the clinical and non-clinical areas regarding claim errors and/or denials, and for providing cross coverage for areas not primarily assigned as required to ensure efficient and professional operations and maximum patient satisfaction.
Inpatient Corporate Coder - Remote based in the US Other StaffInpatient Corporate Coder - Remote based in the USDallas, TXRemote$26.40–$39 / hourThere are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. The CC is responsible for coding of Tenet facilities as assigned, assisting with productive coding to maintain DNFC, assisting with quality chart reviews, assisting with the training of new CC’s and/or other projects where indicated.
Auditing & Education Consultant-Profee CorroHealth IncAuditing & Education Consultant-ProfeeTXRemoteEssential Functions: Perform complex, concurrent and/or retrospective analysis of medical record documentation to Validate coded data as recognized by the AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, and CPT Assistant. JOB SUMMARY: Serves in a consulting role by evaluating the work of client's coders in their assignment of ICD-10, CPT and/or HCPCS codes to hospital inpatient, outpatient and/or physician practice encounters.
Clinical Nurse Reviewer Zelis Healthcare, Inc.Clinical Nurse ReviewerPlano, TX$59,000–$75,050 / yearThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Health Information Manager HIM ClearSky HealthHealth Information Manager HIMMansfield, TexasSafeguards the confidentiality of all medical records by ensuring the Release of Information policy is followed in accordance with HIPAA and other requirements; securing legal/risk management records; responding timely to subpoenas and/or court orders; and representing the hospital in court hearings and/or depositions as required. Oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization’s policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the healthcare organization’s information privacy practices.
Health Information Management (HIM) Manager ClearSky HealthHealth Information Management (HIM) ManagerMansfield, TexasSafeguards the confidentiality of all medical records by ensuring the Release of Information policy is followed in accordance with HIPAA and other requirements; securing legal/risk management records; responding timely to subpoenas and/or court orders; and representing the hospital in court hearings and/or depositions as required. Oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization’s policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the healthcare organization’s information privacy practices.
Medical Practice Assistant Parkland HospitalMedical Practice AssistantDallas, TXProactively outreaches to patients using motivational interviewing, demonstrating effective, caring communication to build patient trust and establish and maintain relationships to gather information, encourage patient self-interest in healthcare, and follow up on patient-established goals. Assists patients and families with health system navigation, making appointments, patient advocacy, determination of community resources to reduce barriers to care, and support set-up and initiation of electronic communication modes (email, MyChart, etc.).