Clinical Investigator Behavioral Health Centene Corporation GroupClinical Investigator Behavioral HealthRemote-TX, TXRemote$56,200–$101,000 / yearPosition requires the associate to verify authorization for services and written documentation of services provided against claim information, ensure the appropriateness and accuracy of diagnosis and procedure codes supporting such claims, coordinate medical necessity and appropriate level of care determinations with Medical Directors, and validate services against CMS and State-specific coverage, limitations and exclusion guidelines. 2+ years clinical experience with independent license required; 2 years of fraud, waste, and abuse experience required; experience in provider education and managed care organization preferred; coding certification preferred.
Data Entry clerk Qureos IncData Entry clerkDallas$18–$25 / hourDoctor Management Service is a leading provider of medical billing and coding services, with 15 years of experience supporting physicians and healthcare facilities across the USA. We are currently seeking a meticulous and highly organised Data Entry Clerk to join our dynamic team in Dallas.
Senior Internal Auditor Parkland HospitalSenior Internal AuditorTXCertified Internal Auditor (CIA), Certified Public Accountant (CPA), Registered Health Information Administrator (RHIA), Registered Nurse, or similar healthcare-related designation required upon hire or commitment to obtain within two (2) years from date of entry into position. Plan, lead, and execute complex audit engagements across various healthcare functions including clinical operations, revenue cycle, billing, coding, and regulatory compliance to detect errors or irregularities and ensure compliance with relevant laws, regulations, and guidelines of Federal and State programs.
Mgr, Revenue Cycle Texas OncologyMgr, Revenue CycleRichardson, TexasOur founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Supports all activities associated with the direction, coordination, implementation, execution, control and completion of projects that relate to critical business goals while ensuring consistency with company strategy, commitments and goals.
Field Reimbursement Manager Syneos - Commercial - ProdField Reimbursement ManagerDallas, TX$150,000–$160,000 / year5+ years’ experience pharmaceutical and/or biotech experience and 2+ years’ relevant experience in the following: patient journey navigation, payer, reimbursement, medical billings & coding, specialty pharmacy & distribution, and patient support services engagement. Provide information to HCP on how the products are covered under the benefit design and educate key private and public payer coverage and changes that impact the products access for patients.
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.
Senior Analyst, Payment Integrity Disputes Oscar HealthSenior Analyst, Payment Integrity DisputesDallas, TXRemote$64,832–$85,092 / yearYou will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement. Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah.
Hospital AR Collector – Level III United Surgical Partners InternationalHospital AR Collector – Level IIIDallas, TXPersonal qualities of integrity, credibility, accountability, and commitment to the organization; displays a proactive, hands-on approach partnering with stakeholders to enhance overall value and visibility of the organization. Completes in-depth reviews and timely follow ups on high-dollar accounts (typically $10,000 and above) to ensure claim resolution to obtain maximum reimbursement.
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.
Clinical Special Investigations Unit Investigator- Health Plan Parkland HospitalClinical Special Investigations Unit Investigator- Health PlanTXMust be currently certified and in good standing or obtain certification within twelve (12) months of hire with one of the following: Health Care Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Investigator (AHFI), Association of Certified Fraud Examiners (CFE), or National Health Care Anti-Fraud Association (NHCAA). Responds to Requests for Information (RFIs) from National Benefit Integrity MEDIC, U.S. Office of Personnel Management Office of the Inspector General (OPM OIG), State Departments of Insurance (DOI), and other law enforcement agencies, as appropriate.
Reimbursement Supervisor STONEBRIDGE INDEPENDENT COUNELING CENTERReimbursement SupervisorMcKinney, TXFull timeThis role oversees a team of specialists to ensure accurate claim submissions, payment collections, compliance with payer and regulatory requirements, and timely resolution of billing issues. The Reimbursement Manager also plays a key role in training, workflow optimization, and payer communication to ensure the financial health of the organization.
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).
Tech Lead Yantran LLCTech LeadPLANO, TXWe are seeking a highly skilled Senior FullStack Developer with a strong focus on ReactJS to join our dynamic team at TechM Chennai TMCC. The ideal candidate will have 7 10 years of experience in software development, demonstrating a deep understanding of front end technologies and a passion for building high quality web applications.
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.
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.
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.
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.
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.
Revenue Integrity Technician Parkland HospitalRevenue Integrity TechnicianTXStays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Maintains positive working relationships with other hospital departments such as Patient Financial Services, Medical Records, Compliance, and Clinical areas to ensure that the responsibilities of the department are performed in an expeditious and thorough manner.