- CRC Insurance Services, Inc. (TX)
- …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... Responsible for overseeing, managing and supporting all activities of the claims employees and operations of the department. **ESSENTIAL DUTIES AND… more
- Conduent (Dallas, TX)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (Dallas, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead (Bodily Injury + PIP) **PRIMARY PURPOSE** : To supervise a team… more
- Sedgwick (Austin, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead, General Liability **PRIMARY PURPOSE** : To supervise a team of… more
- Sedgwick (San Antonio, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance General Liability Claims Team Lead | Remote TX | Dedicated Client **_Are you looking for… more
- Ascension Health (Austin, TX)
- …requirements established by Health and Human Services Commission. Perform routine and/or targeted audit of claims to ensure payment accuracy and adherence to ... agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine appeal outcomes. + Composes all… more
- TEKsystems (Houston, TX)
- …insurance follow up, root cause analysis, EHR, EMR, EPIC, Cerner, medical billing, claims audit , appeals process, appeals letter, denials, insurance follow ups ... possible) 1. heavy research - will be assigned an audit of varying volume of accounts will either be...phone to communicate and solve problems - determine why claims are denied - determine where to send appeals… more
- TEKsystems (Austin, TX)
- …Required Skills + Revenue cycle appeal and denial resolution + Insurance follow-up and claims audit + Appeals letter writing and submission + EMR/EHR experience ... client satisfaction. A Typical Day Includes: 1. Heavy Research ( Audit Analysis) + Assigned audits may vary in volume...steps. 2. Rebilling & Appeals Submission + Focus on claims ready for appeal-already vetted and prioritized. + Write… more
- Centene Corporation (Austin, TX)
- …anywhere in the Continental United States. **Position Purpose:** Direct and oversee claims audit operations and medical code editing scenarios. Oversee payment ... years of Managed Care or CMS related experience, including compliance, claims , payment integrity, or special investigation experience required. + Previous management… more
- The Cigna Group (Plano, TX)
- …and data informatics and data exchange using healthcare and clinical data such as Claims , Membership, Audit , Client Structure, and Benefits. If you will be ... using Tableau and Looker to create dashboards for campaigning and other internal audit reports; using Python to understand the ETL workflow; using ServiceNow to… more