- The Cigna Group (Houston, TX)
- **Job Summary:** The Medicare Coding Quality Review Audit Manager is responsible for day-to-day oversight of the Risk Adjustment coding quality ... is broadened. + Plans, develops, implements, and monitors Cigna's Medicare 's QA of coding projects. + Monitors...as designed + Works closely with Quality Review Audit Advisor to ensure Risk Adjustment coding… more
- Elevance Health (Houston, TX)
- …a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid ... of Care, trend management, value-based care support for STARS/HEDIS and correct coding initiatives with providers as well as strategic growth and innovation… more
- The Cigna Group (Houston, TX)
- …occur be before/after normal business hours) + Perform the minimum number of coding quality reviews consistent with established departmental goals. + Maintain ... provider groups (PODs/IPAs). + Accountable to complete and accurate review of multi-year diagnosis coding of assigned...audit departments regarding compliance, coding , and inappropriate coding . + Attend risk adjustment and quality … more
- Houston Methodist (Katy, TX)
- …+ Knowledge of patient account charge processes and a comprehensive understanding of Medicare coding rules and regulations + Ability to follow-through and handle ... and revenue cycle staff as needed on regulatory items related to compliant coding on the claim. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Meets or exceeds… more
- Diversicare Healthcare Services & Diversicare Ther (Houston, TX)
- …completes designated sections of the MDS assessment. 6. Ensures and completes accurate coding of the MDS assessment with information obtained via medical record ... review , observation and interview with center staff, patients, residents...members. 7. Ensures documentation is available to support accurate coding of the MDS assessment. 8. Maintains the tracking… more
- Aveanna (Houston, TX)
- …and Coverage Specialist will report to the Director of Regulatory Compliance and Quality Review . The Regulatory Compliance and Coverage Specialist will complete ... of 2 years experience in healthcare compliance related activities (clinical record review , quality + assurance, performance improvement, auditing, or utilization… more
- Apex Health Solutions (Houston, TX)
- SUMMARY: Risk Adjustment Coder is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10 coding ... Coder (CRC) * Certified Professional Coder (CPC) * Certified Coding Specialist (CCS) EXPERIENCE: * Minimum of three (3)...(3) years HCC experience performing retrospective risk adjustment chart review required. * Minimum of three (3) years of… more
- CenterWell (Houston, TX)
- …* Completes all medical record documentation in a timely manner working with a quality - based coder to optimize coding specificity. * Follows policy and protocol ... defined by Clinical Leadership. * Meets with RMD about quality of care, review of outcome data,...Medicine preferred * Active and unrestricted DEA license * Medicare Provider Number * Medicaid Provider Number * Minimum… more
- MD Anderson Cancer Center (Houston, TX)
- …recommendations for resolution 7. Pursues appeals when available. Initiates communication with coding team and clinical staff when coding related and medical ... is documented clearly, so that various departments involved in resolution can review the account 10. Achieves improved team performance by completing assigned… more
- MD Anderson Cancer Center (Houston, TX)
- …recommendations for resolution. 5. Pursues appeals when available. Initiates communication with coding team and clinical staff when coding related and medical ... is documented clearly, so that various departments involved in resolution can review the account. 8. Achieves improved team performance by completing assigned… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …to assist with the entry of prior authorization requests for utilization review . This includes interpretation and communication of covered benefits and exclusions, ... or other managed care setting. Experience in creating authorization requests or billing Medicare or private insurance companies. Preferred: Knowledge of CPT & ICD 10… more
- HCA Healthcare (Houston, TX)
- …health, public nursing or acute hospital nursing experience + Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS ... to establish and achieve patient goals and maintain high quality patient care. Performs in accordance with physician's orders... care during their recovery at home. We are Medicare certified. Our patients are under the supervision of… more
- CenterWell (Houston, TX)
- …+ Completes all medical record documentation in a timely manner working with a quality - based coder to optimize coding specificity. + Follows policy and protocol ... Meets with Area Medical Director and Lead Cardiologist about quality of care, review of outcome data,...pump + Work experience in electrophysiology + Experience managing Medicare Advantage panel of patients with understanding of Best… more
- Houston Methodist (Houston, TX)
- …Office (CBO). This includes, but is not limited to, resolution of charge review (where applicable) and claim edits, payor rejections, unresolved or no response ... Provides support for the revenue cycle departments (as applicable: payment posting, coding and accounts receivable (AR) follow up) related to administrative duties… more
- Sedgwick (Houston, TX)
- …claimant and client. + Ensures claim files are properly documented and claims coding is correct. + May process low-level lifetime medical and/or defined period ... filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and… more