- Fresenius Medical Center (Abilene, TX)
- …or other situations change. + Completes and follows up with paperwork when claims are disputed for non-payment. + Collects necessary documents to completed initial ... caseloads; Analyzes patient reports from billing systems as an audit check to ensure the correct insurance information is...basis as required by QA processes + Completes monthly audit exam to stay current on internal policies. +… more
- Humana (Austin, TX)
- …operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes ... operational efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify opportunities and… more
- Molina Healthcare (TX)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- New Jersey Resources (Houston, TX)
- …changes to address deficiencies, improve programs and ensure company maintains an audit -ready status at all times. * Develop and maintain excellent working ... response analysis reviews. * Assist in managing Workers' Compensation Claims , Return to Work programs, accident reports, claims... Claims , Return to Work programs, accident reports, claims and lead root cause analysis. * Interface with… more
- Houston Methodist (Houston, TX)
- …Compliance and other committees as required. Works collaboratively with the Internal Audit and Business Practices to respond to deficiencies and to strengthen ... Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the following:… more
- Walgreens (Colleyville, TX)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... companies as well as medical providers and conducts or participates in 3rd party audit . + Assists and supports Store Manager and Pharmacy Manager in analyzing and… more
- Centene Corporation (Austin, TX)
- …calls with members and provider offices to provide resolution to claims (ie: additional information requests and medication determination updates) + Thoroughly ... + Presents proposed solutions in a clear and concise manner + Assists with audit preparation as needed + Assists with miscellaneous special project work as assigned… more
- Citigroup (Irving, TX)
- …+ Possible interaction with other counterparties around positions and outstanding balances/ claims + Supports an expansive and/or diverse array of products (risk ... monitors errors to suggest solutions to reduce errors, and to adhere to audit and control policies. Often related, but not limited to loan documentation processes.… more
- Datavant (Austin, TX)
- …**Quality, Compliance, and Scalability** + Ensure analytics products support audit defensibility, regulatory compliance, and documentation traceability. + Design ... SDLC. + **Technical Acumen:** Comfortable working with large datasets, EHR data, claims data, and HCC-based analytics. Familiarity with query languages such as SQL,… more
- Walgreens (Dallas, TX)
- …to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows- up with ... companies as well as medical providers and participates in 3rd party audit . + Follows-up with medical providers' offices to clarify prescribed medications, dosages,… more
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