Top 132 Medical record reviewer Jobs in Texas

DRG Reviewer
Machinify —Dallas, TX
- $90,000 - $115,000 a year
- Remote
- Nursing
- HIPAA
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Medical Records Reviewer
Bienvivir All Inclusive Health —El Paso, TX
- Full-time
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- 403(b) matching
- Mileage reimbursement
5d
Bilingual Medical Assistant
Qoros Cardiovascular Care —Houston, TX
- From $17 an hour
- Full-time
- Private practice
- Spanish
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Utilization Management Representative II
Elevance Health —San Antonio, TX
- 8 hour shift
- Mid-level
- High school diploma or GED
- Analysis skills
- Employee stock purchase plan
- Paid holidays
5d
Clinical Director
Loyal Source —San Antonio, TX
- From $200 an hour
- Medicine
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Senior Fire Alarm Technician (Lubbock Location)
Johnson Controls —Lubbock, TX
- $24.32 - $36.00 an hour
- Weekends as needed
- Customer service
- 5 years
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Fire Sprinkler Systems Technician 3
Johnson Controls —Austin, TX
- $23.07 - $28.00 an hour
- Full-time
- Background check
- Clean driving record
- Customer service
- Paid holidays
- Health insurance
Quick Apply
Clinical Quality Analyst
Optum —Dallas, TX
- $29 - $52 an hour
- Overtime
- Remote
- Microsoft Word
- 18 years or older
- Pass drug screening
- On-the-job training
4d
Outside Scheduler/Insurance Reviewer Sr–Remote
Texas Oncology —Odessa, TX
- Monday to Friday
- HIPAA
- Research
- High school diploma or GED
- Wellness program
- Disability insurance
Insurance Reviewer-Clinical
Texas Oncology —Fort Worth, TX
- Full-time
- HIPAA
- Research
- Mid-level
11d
Research Data Coordinator
MD Anderson —Houston, TX
- $21.15 - $31.73 an hour
- Full-time
- Hybrid work
- Word processing
- No experience needed
- Mid-level
- AD&D insurance
- Paid holidays
Medical Claims Reviewer
OSI VISION LLC —Randolph A F B, TX
- $40,881.93 - $45,664.26 a year
- Background check
- Microsoft Excel
- Mid-level
- Dental insurance
- Vision insurance
Quick Apply
Life Care Planner
Dane Street, LLC —Dallas, TX
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
Medical Assistant Clinic Reviewer - FT - Days - Bariatrics (RHIT Required)
DHR Health —Edinburg, TX
- Full-time
- Microsoft Excel
- Surgery
- OSHA
13d
Freelance Medical & Billing Coder
Dane Street, LLC —Houston, TX
- Medical office experience
- Mid-level
- Quality control
Quick Apply
Patient Benefits Representative
Texas Oncology —Amarillo, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance
RN Quality Assurance Reviewer
Essential Healthcare Solutions LLC —Texas
- Surgery
- Nursing home
- Licensed Clinical Social Worker
- Paid holidays
- Disability insurance
Quick Apply
Patient Benefit Representative
Texas Oncology —Austin, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance
Patient Benefits Representative I
Texas Oncology —San Marcos, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance
13d
Patient Benefits Representative Garland
Texas Oncology —Garland, TX
- Full-time
- Microsoft Excel
- HIPAA
- Finance

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medical record reviewer jobs near texas

DRG Reviewer

Machinify -
Dallas, TX

Quick Apply

Job Details

$90,000 - $115,000 a year

Benefits

Health savings account
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching

Qualifications

Root cause analysis
Clinical documentation standards
Healthcare coding investigations
DRG

Full Job Description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

About the Opportunity

As part of the Complex Payment Solutions Team, you will, as a DRG Reviewer, be a key contributor responsible for conducting thorough DRG payment validation reviews, including clinical and coding assessments, of medical records and related documentation in accordance with contract-specific review criteria. This position requires an in-depth understanding of clinical guidelines, coding protocols, and regulatory requirements to ensure accurate payment determinations.

In this role, you will meticulously document findings, provide detailed clinical, policy, and regulatory support and collaborate with relevant stakeholders to ensure compliance with payment standards. Your expertise will be critical in ensuring that payment decisions are supported by accurate and complete documentation, ultimately contributing to the integrity and efficiency of the payment process.

What you'll do

Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Conduct audits in alignment with organizational quality and timeliness standards.
Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
Recommend improvements to the audit system to enhance efficiency.
Ensure compliance with HIPAA regulations for protected health information.
Perform other duties as assigned.

What you bring (Role Requirements)

Education Requirements:

An associate or bachelor's degree in nursing (active/unrestricted license); or in health information management is required.
Work experience may be considered in lieu of formal education at leadership discretion.

Certification (at least one of the following is required):

RHIA - Registered Health Information Administrator
RHIT- Registered Health Information Technician
CCDS - Certified Clinical Documentation Specialist
CDIP - Clinical Documentation Improvement Practitioner
CCS - Certified Coding Specialist
CIC - Certified Inpatient Coder

Qualifications:

Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
Strong focus on quality and attention to detail.
Deep curiosity and analytical skills to understand root causes of events and behaviors.
Proven ability to apply critical judgment in clinical and coding determinations.
In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
Expert in DRG methodologies (e.g., MS & APR).
Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA's Coding Clinic Guidelines.
Ability to work independently and efficiently with minimal supervision.

What We Offer:

Work from anywhere in the US! Machinify is digital-first.
Top Medical/Dental/Vision offerings
FSA/HSA
Tuition reimbursement
Competitive salary, 401(k) with company match
PTO
Additional health and wellness benefits and perks
Flexible and trusting environment where you'll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks.

Pay range: $90,000 - $115,000, plus quarterly bonus.

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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Refine Your Search

medical record reviewer jobs in texas

DRG Reviewer

Medical Records Reviewer

Bilingual Medical Assistant

Utilization Management Representative II

Clinical Director

Senior Fire Alarm Technician (Lubbock Location)

Fire Sprinkler Systems Technician 3

Clinical Quality Analyst

Outside Scheduler/Insurance Reviewer Sr–Remote

Insurance Reviewer-Clinical

Research Data Coordinator

Medical Claims Reviewer

Life Care Planner

Medical Assistant Clinic Reviewer - FT - Days - Bariatrics (RHIT Required)

Freelance Medical & Billing Coder

Patient Benefits Representative

RN Quality Assurance Reviewer

Patient Benefit Representative

Patient Benefits Representative I

Patient Benefits Representative Garland

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