- Prime Therapeutics (Austin, TX)
- …Pharmacy Benefit Management experience to include 1 year of work experience in an operations, audit or quality assurance environment + Must be eligible to ... for error; utilize analytics and professional knowledge to select claims or pharmacies for audit in alignment...new ideas and work collaboratively to provide the highest quality of care and service to our members. If… more
- Houston Methodist (Houston, TX)
- …risk and identify and capture potential revenue opportunities. This position performs quality assurance , detailed claims analysis and medical record ... are being billed to patients and third-party payers. Performs quality assurance . **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Proactively stays up-to-date… more
- PennyMac (Fort Worth, TX)
- …+ Develop required process infrastructure, policies, procedures, and operational routines + Audit functions/ quality assurance of key processes to ensure ... of homeownership through the complete mortgage journey. A Typical Day The Claims Supervisor is responsible for providing structure and oversight to the post-sale… more
- Elevance Health (Grand Prairie, TX)
- …at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance , or recovery auditing. + Requires at least one ... responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of...Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad knowledge… more
- Banner Health (TX)
- …documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. ... different focuses (Facility vs Profee)._ In this **Inpatient Facility-based HIMS Coding Quality Associate** position, you bring your **5 years of acute care… more
- AUI Partners (TX)
- … control measures, and drive continuous improvement initiatives. Develop & Implement AUI's Quality Control/ Quality Assurance Program: Develop and implement a ... assist in the management of mitigating and resolving potential claims . Assist in reviewing Plans do quality ...review of drawings when requested. Monitor and Enforce AUI's Quality Control/ Quality Assurance Program: Coordinate… more
- Elevance Health (Grand Prairie, TX)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes...to generate audit determinations and formulate detailed audit findings letters. + Maintains accuracy and quality… more
- CVS Health (Irving, TX)
- …for analyzing client requests and performing the necessary benefits testing and quality assurance . You'll work alongside BRMs, Benefits Coders and Testers, ... is important for this role, as your testing and quality assurance activities will impact not only...to apply logical thinking and investigating skills to research claims issues, formulate a strategic approach to efficiently build… more
- Citizens (Irving, TX)
- …of funds to resolve accounts and managing staffing and miscellaneous costs + Review Quality Assurance / Quality Control reports on a daily/weekly basis and ... the department and takes ownership for producing high volume and high- quality work while adhering to investor and regulatory guidelines. Primary… more
- Mass Markets (Killeen, TX)
- …as quality assurance , training, IT, and recruiting. + Develop and audit quality assurance strategies to ensure the delivery of world-class service ... originating from a call center + Proven ability to meet performance, efficiency, and quality assurance targets + Monitoring of individual and team results to… more
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