- Sedgwick (Austin, TX)
- …of a client Disability Pension Board + Review of identified appeal cases for quality assurance purposes + Voting member to determine if eligibility requirements ... regulations, and client service requirements and assure efficient, cost effective, quality program delivery for medical and disability management. + Coordinating and… more
- Molina Healthcare (TX)
- …data governance initiatives, including metadata management, lineage tracking, and quality assurance . **Job Qualifications** **Required Qualifications** * Minimum ... models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional teams, including data… more
- Defense Health Agency (Fort Sam Houston, TX)
- …and Accountability Act (HIPAA) standards. + Participate in Continuing Medical Education and quality assurance activities. + Moderate to heavy lifting up to 45 ... providers as they are covered by the Federal Tort Claims Act (28 USC | 1346(b)) while acting within...or committee meetings; participate in Continuing Medical Education and Quality Assurance activities. + Performs Other Duties… more
- Baylor Scott & White Health (Plano, TX)
- …as needed and in conjunction with the Manager or Supervisor. + Performs quality assurance audits. + Orders supplies as requested. **Key Success Factors** ... in a physician's office, clinic, or other area. This role ensures high- quality , patient-centered care. This senior position handles complex tasks and escalations. It… more
- Zelis (Plano, TX)
- …to determine and document business requirements. + Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections. + ... team to refine into user stories with acceptance criteria, including creating test cases/ claims with expected pricing outcomes . + Perform analysis of various data… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …with experience on a one-to-one basis Preferred Experience Coding, auditing or quality assurance review experience. Bilingual (English/Spanish) Equipment Use of ... and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with… more
- Humana (Austin, TX)
- …Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance , and compliance + Determining root causes driving issues ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families,… more
- Mass Markets (Killeen, TX)
- …updates and key initiatives clearly and effectively. + Collaborate with departments such as Quality Assurance , Training, IT, and Recruiting. + Lead quality ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service,… more
- Centene Corporation (Austin, TX)
- …activities. + Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... to providers that would improve utilization and health care quality . + Reviews claims involving complex, controversial, or unusual or new services in… more
- Sedgwick (Austin, TX)
- …completed documentation from providers to ensure accuracy, completeness, adherence to quality assurance standards. + Determine the outcome of involvement ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more