Medical Reviewer Job at Cantex Continuing Care Network, Carrollton, TX

cGJVRFlLcEFIeWEyZmlUYWdEd1VaSUMyOVE9PQ==
  • Cantex Continuing Care Network
  • Carrollton, TX

Job Description

Job Details Job Location Cantex Corporate - Carrollton, TX Position Type Full Time Job Category Compliance Description Summary: The Revenue Compliance Analyst ensures accurate documentation, coding, and billing practices at Cantex. This role supports the Revenue Compliance and Reimbursement teams in safeguarding revenue and maintaining regulatory compliance. Qualifications Key Responsibilities: Review clinical documentation for accuracy and completeness in accordance with CMS and OIG regulations. Audit claims for correct diagnosis and CPT coding, billing accuracy, and timely submission. Identify trends in denials or billing errors and recommend corrective actions. Collaborate with the Compliance Department on internal audits. Support training efforts for clinical and billing staff on documentation standards. Complete and review Additional Documentation Requests (ADRs), Appeals, Quality of Care (QOC) and Risk Analysis (RA) from Managed Care and Medicare entities. Provide information or feedback/ recommendations. Demonstrate professionalism in communication to various departments and outside entities. Monitor the effectuations of all resolution / outcomes related to the above pertaining to ADRs, Appeals, QOC and RA. Complete audits in various areas according to rules and regulations and offer positive or constructive feedback. Manage government probes, including educating on the process, and develop corrective action plans as needed. Regulatory research by performing comprehensive research related to payer guidance, facts and circumstances impacting payment outcomes. Communicate as a revenue liaison with payers, providers and billing. Be able to travel periodically to various facilities and sites Able to work on computer and use technology to complete work. Qualifications: Nurse or Therapist for minimum of 5 years who has worked in or familiar in the areas of SNF, Home Health, Hospice Must have coding certification or certifications that assist with auditing. We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package. Diversity, Equity and Inclusion are at the heart of Pivot Rehab. We are committed to a culture that respects our differences and values the contribution of all people. #Corp Cantex Continuing Care Network

Job Tags

Full time,

Similar Jobs

Host Healthcare

Local Contract Respiratory Therapist - $49-53 per hour Job at Host Healthcare

Host Healthcare is seeking a local contract Respiratory Therapist for a local contract job in Hershey, Pennsylvania. Job Description & Requirements ~ Specialty: Respiratory Therapist ~ Discipline: Allied Health Professional ~ Start Date: 08/26/2025~ Duration...

Lion Freight Systems Inc

CDL A Dry Van Truck Driver - OTR Job at Lion Freight Systems Inc

 ...Experienced CDL-A Dry Van Drivers Needed Earn $1,800$2,300 Weekly! Pay: $0.60/mile all miles paid (empty & loaded). Weekly Earnings: $1,800$2,300 based on mileage driven. Additional Pay: Detention, layover, and extra stops. Bonuses: Safety bonuses... 

Accent Advisor

Online ESL Teacher Job at Accent Advisor

Join our dynamic team and be a part of an innovative online learning platform that connects students around the world with dedicated teachers. We are committed to providing high-quality language education, fostering cultural exchange, and empowering students to achieve... 

Medix™

Clinical Research Assistant - 243281 Job at Medix™

 ...We are seeking a motivated and detail-oriented Clinical Research Assistant to join our team. This role involves coordinating and assisting Clinical Research Coordinators and the rest of the team in the clinical and administrative activities of. Key Responsibilities:... 

Plastipak Holdings

Forklift Operator - Earn $19.25 Job at Plastipak Holdings

 ...Job Description As a Forklift Operator, you safely & efficiently move & store raw materials & finished goods between the warehouse & production areas. At our company, Associates take pride in maintaining our high quality standards & our positive team culture. Were...