- NTT America, Inc. (Houston, TX)
- …which involves Payor Platform configuration, perform UAT, Integration Testing and Audit . Our NTT Business Process Outsourcing (BPO) team has helped client ... per the requirement and according to defined business rules of new claims processing platform. + Evaluation of Configuration Requirement and Formulation of… more
- UTMB Health (Galveston, TX)
- …prevention of duplicate discounts and drug diversion to ineligible patients. Prepares self- audit reports. Ensures records and documentation for the 340B program are ... compliance and performance.Maintains copies of reports for compliance and audit purposes. + Participates in on-site mock HRSA audits...+ Partners with IS and RCO departments to ensure claims are going out with the correct modifiers and… more
- Baylor Scott & White Health (Dallas, TX)
- …regularly with Health Plan operations on network configuration, provider data and audit function (the provider data integrity unit). This position could be based ... practices. - Leads the development and implementation of an audit program that resolves issues and errors and adjusts...consistency between contract terms and adjudication of authorizations and claims . - Plays a critical role in overseeing pricing… more
- Highmark Health (Austin, TX)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Molina Healthcare (Fort Worth, TX)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior… more
- Banner Health (TX)
- …information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper ... to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials...as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all… more
- ManpowerGroup (Houston, TX)
- …Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third ... Health Plan metrics, policies, regulations, and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from… more
- Walmart (Temple, TX)
- …evaluating air water and waste pollution Supports regulatory visits and prepares audit reports for management review Participates in evaluating pollution control and ... for accidents Reports safety violations and accidents Implements internal and external audit requirements within assigned area of work Creates action plans to… more
- CACI International (San Antonio, TX)
- …through various other information systems; + Coordinate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA), if applicable to ... verify audit status, and/or final project acceptance by the Government;...writing system, preparing draft DD Form 1594s, release of claims , memos for record, and any other documentation deemed… more
- Prime Therapeutics (Austin, TX)
- …Program Integrity Audits including outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results ... + Available for consultation in pharmacy related questions to resolve claims submission related to medication edits. + Contacts physicians/prescribers to obtain… more