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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
NewAR Specialist I Methodist Health SystemAR Specialist IDallas, TXNamed 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. Work Shift: Job Description: Your Job: Working with one or more account receivables management system modules including but not limited to billing, claim corrections, reconciliation, payment posting, refunds/credit balances, customer service, and follow-up in accordance with the departmental protocol with an emphasis on maximizing customer satisfaction and profitability.
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.
Supervisor, DRG Revenue Integrity - REMOTE CorroHealthSupervisor, DRG Revenue Integrity - REMOTEPlano, TexasRemoteThis role ensures compliance with AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, CPT Assistant, and official coding guidelines, while supervising a team of auditors. The Supervisor, DRG Integrity Reviews/Audits, is responsible for overseeing the execution, quality, and delivery of complex, concurrent, and retrospective coding audits.
DRG Revenue Integrity Auditor - REMOTE CorroHealthDRG Revenue Integrity Auditor - REMOTEPlano, TexasRemoteThe DRG Revenue Integrity Auditor (DRG-A) performs comprehensive Diagnostic Related Group (DRG) validation and quality audits on inpatient medical records to ensure accurate representation of each patient's clinical story. As a global healthcare solutions company, we invest in our people through continued education, career advancement opportunities, mentorship from industry experts, and a flexible work environment that supports work-life balance.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNDallas, TexasOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
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.
NewHIM Manager/Coder Ernest HealthHIM Manager/CoderPlano, TexasFull timeProvide expertise in the areas of coding and classification systems to healthcare providers throughout our hospital, and help drive improvements of reimbursement, and the revenue cycle. The HIM Manager/Coder is part of the hospital’s leadership team, working closely with CEO and Clinical Director’s.
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.