- Elevance Health (Houston, TX)
- ** Claims Auditor I** **Virtual:** This role...and post payment and adjudication audits of high dollar claims for limited lines of business, claim ... an accommodation is granted as required by law._ The ** Claims Auditor ** **I** is responsible for pre...dollar claims while maintaining acceptable levels of claims inventory and age. + Ensures claim … more
- Conduent (Dallas, TX)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- WTW (Dallas, TX)
- **Description** As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader ... administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report. You will… more
- Elevance Health (Houston, TX)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Sedgwick (San Antonio, TX)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** **This is a fully remote position, and candidates residing in any ... United States are encouraged to apply. As an Attorney Auditor at Sedgwick, you'll have the opportunity to take...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Elevance Health (Grand Prairie, TX)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Houston, TX)
- **Clinical Provider Auditor II** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, ... is granted as required by law. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities...abuse. **How you will make an Impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Elevance Health (Grand Prairie, TX)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Highmark Health (Austin, TX)
- …and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting ... Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician...skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and… more
- Aramco Services Company (Houston, TX)
- OVERVIEW: This position serves as the in-charge auditor on large, complex and sensitive internal auditing assignments. Audits are directed at reviewing internal ... and researches evidence/documents to analyze the overall fact pattern of claim and synthesize data into a professional report with recommendations. Interviews… more