Coding Auditor
Abilene, TX · On-site
$26.25 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Coding Auditor
Abilene, TX · On-site
$26.25 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Coding Auditor
Abilene, TX · Remote
$26.50 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Coding Auditor
Abilene, TX · Remote
$26.50 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Coding Auditor
Abilene, TX · On-site
$26.50 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Coding Auditor
Abilene, TX · On-site
$26.50 - $30/hr
Knowledge of disease pathophysiology and drug utilization * Knowledge of MS-DRG classification and ... Ability to demonstrate initiative and discipline in time management and assignment completion
Registered Nurse (RN) - Compliance Auditor (Hybrid)
Dallas, TX · On-site
$2.2K/wk
Collaborate with clinical, revenue cycle, finance, legal, care management, health information ... Experience conducting clinical quality reviews, utilization reviews, or compliance audits. * Prior ...
Quick apply
Registered Nurse (RN) - Compliance Auditor (Hybrid)
Dallas, TX · On-site
$2.2K/wk
Collaborate with clinical, revenue cycle, finance, legal, care management, health information ... Experience conducting clinical quality reviews, utilization reviews, or compliance audits. * Prior ...
Clinical Manager RN, STAR PLUS - El Paso, TX - Remote
El Paso, TX · Remote
$91K - $163K/yr
... not limited to: utilization management, provider relations, operations, finance, quality ... Conduct ride-along and telephonic auditing to support a part of staff evaluation and monitoring
Clinical Manager RN, STAR PLUS - El Paso, TX - Remote
El Paso, TX · Remote
$91K - $163K/yr
... not limited to: utilization management, provider relations, operations, finance, quality ... Conduct ride-along and telephonic auditing to support a part of staff evaluation and monitoring
Clinical Manager RN, STAR+PLUS - El Paso, TX - Remote
El Paso, TX · On-site +1
$91K - $163K/yr
... not limited to: utilization management, provider relations, operations, finance, quality ... Conduct ride-along and telephonic auditing to support a part of staff evaluation and monitoring
Clinical Manager RN, STAR+PLUS - El Paso, TX - Remote
El Paso, TX · On-site +1
$91K - $163K/yr
... not limited to: utilization management, provider relations, operations, finance, quality ... Conduct ride-along and telephonic auditing to support a part of staff evaluation and monitoring
... utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B ... managed care, and commercial insurance payment requirements • Excellent attention to detail ...
... utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B ... managed care, and commercial insurance payment requirements • Excellent attention to detail ...
... utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B ... managed care, and commercial insurance payment requirements • Excellent attention to detail ...
... utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B ... managed care, and commercial insurance payment requirements • Excellent attention to detail ...
Director-Audit (On-Site)
Houston, TX · On-site
... and disciplined management of litigation exposure while fostering strategic growth, market ... Optimize auditor utilization rates and profitability of billable hours. * Develop and monitor KPIs ...
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Director-Audit (On-Site)
Houston, TX · On-site
... and disciplined management of litigation exposure while fostering strategic growth, market ... Optimize auditor utilization rates and profitability of billable hours. * Develop and monitor KPIs ...
Quality Assurance Spec II
Big Spring, TX · On-site
$3.7K - $5.9K/wk
... QSO, Utilization Management (UM), Facility Support Performance Improvement (FSPI), other ... Provides education and support to auditors. Completes data entry within the time constraints ...
Quality Assurance Spec II
Big Spring, TX · On-site
$3.7K - $5.9K/wk
... QSO, Utilization Management (UM), Facility Support Performance Improvement (FSPI), other ... Provides education and support to auditors. Completes data entry within the time constraints ...
Legal Counsel
$144K - $288K/yr
... management, utilization management, and related clinical operations. * Advise clients on the ... party auditors or examiners with respect to healthcare matters * Admitted to practice law in at ...
Legal Counsel
$144K - $288K/yr
... management, utilization management, and related clinical operations. * Advise clients on the ... party auditors or examiners with respect to healthcare matters * Admitted to practice law in at ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
... effective utilization and process compliance * Support the accurate compilation, analysis, and ... Coordinate with internal and external auditors and support audit requests in a timely and efficient ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
Oversee equipment maintenance to maximize utilization and life expectancy. Accountable for ... Responsible for overseeing and auditing weekly driver payroll. Maintain and forecast direct and ...
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
Quick apply
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
Benefits Administrator
Plano, TX · On-site
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
Benefits Administrator
Plano, TX · On-site
... manages the continuous flow and auditing of eligibility data using Google Workspace, while actively monitoring claims utilization to ensure plan benefits are used accurately and cost-effectively. As ...
Utilization Management Auditor information
What is the difference between Utilization Management Auditor vs Utilization Review Nurse?
| Aspect | Utilization Management Auditor | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like CCM or CUC | Licensed Registered Nurse (RN), often with additional certifications |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinics, insurance companies, often in clinical settings |
| Primary Focus | Auditing and reviewing utilization data for compliance and cost management | Assessing patient care needs and determining appropriate services |
While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.
What are some common challenges faced by utilization management auditors and how can they be addressed?
Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.
What is a utilization management auditor?
A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.
What are the key skills and qualifications needed to thrive as a utilization management auditor?
To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
What are popular job titles related to Utilization Management Auditor jobs in Texas?
For Utilization Management Auditor jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Management Auditor jobs in Texas look for?
The top searched job categories for Utilization Management Auditor jobs in Texas are:
What cities in Texas are hiring for Utilization Management Auditor jobs?
Cities in Texas with the most Utilization Management Auditor job openings:
Job description
- JOB SUMMARY
- Conducts coding compliance audits of inpatient and outpatient encounters to validate code assignment. Follows the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.
- JOB REQUIREMENTS
- Minimum Education
- Associates degree in relevant field preferred or combination of equivalent of education and experience
- Minimum Work Experience
- Five (5) years coding experience including, but not limited to, hospital inpatient and outpatient encounters
- Required Licenses/Certifications
- AHIMA and/or AAPC Coding Credential, CCS preferred
- Required Skills, Knowledge, and Abilities
- Ability to consistently and accurately audit coding of inpatient and outpatient encounters
- Ability to create clear and concise audit reports and maintain productivity standards
- Must successfully pass pre-hire coding assessment
- Knowledge of medical terminology, ICD-10 CM/PCS, EM, and CPT-4 coding guidelines and methodologies
- Knowledge of disease pathophysiology and drug utilization
- Knowledge of MS-DRG classification and reimbursement structures
- Knowledge of APC, OCE, NCCI classification and reimbursement structures
- Must be detail oriented and have the ability to work independently
- Computer knowledge of MS Office
- Must display excellent interpersonal skills
- Ability to demonstrate initiative and discipline in time management and assignment completion
- Ability to work in a virtual setting under minimal supervision
- Designated Driver
- No
- OSHA Category
-
- 3 - Low Risk
- Minimum Education