- WTW (Dallas, TX)
- …environment + Claims processing knowledge/exposure to one or more administrator claim systems such as UNET, WGS, NASCO, ACAS, Proclaim, PowerMHS, Facets, ... Field Auditor , you will apply your medical claims audit, project management and claim processing...Responsibilities** + Understand self-insured client's plan designs + Audit claims using the administrators claims system… more
- Elevance Health (Grand Prairie, 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...quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- Elevance Health (Grand Prairie, TX)
- …preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems , provider billing guidelines, payer ... **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Highmark Health (Austin, TX)
- …to resolve issues and provide advice on new programs. Provides guidance to system entities in response to external coding audits conducted by the Medicare ... the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems , missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure… more
- Elevance Health (Grand Prairie, TX)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Virtual:** This role enables associates to work virtually full-time, with the ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Elevance Health (Grand Prairie, TX)
- **Clinical Provider Auditor II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training sessions, ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II i** s responsible for identifying issues and/or entities that… more
- Molina Healthcare (Houston, TX)
- …is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it ... written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims processing… more
- UIC Government Services and the Bowhead Family of Companies (Plano, TX)
- …a Quality Assurance Manager to lead Bowhead Manufacturing & Product's Quality Management System . The position is located at our facility in Plano, TX. The Quality ... management plans (SPC) + Coaching program team members on Quality Management System requirements + Will conduct process Validation and process Monitoring +… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …Clerk/Coder to assign procedure, and diagnosis codes for insurance billing, review claims data, research, and correspond with insurance companies to obtain accurate ... reimbursement for healthcare claims . This person will also be responsible for analyzing,...Interventional Radiology Cardiovascular Coder (CIRCC) and Certified Professional Medical Auditor (CPMA) + Experience: A minimum of 1 year… more
- Houston Methodist (Houston, TX)
- …jointly with applicable management to deploy the overall strategy for system -wide coding operations consistent with Houston Methodist strategic plans. **PEOPLE ... annual training program budget. + Where applicable assists with pre-billed claim edits to ensure complaint coding, charting and billing. **GROWTH/INNOVATION… more