- Baylor Scott & White Health (Temple, TX)
- …reviews, and reports on quality control activities for all Pharmacy Services Specialist 1 staff. Including review and auditing reports as determined by ... **JOB SUMMARY** The Pharmacy Services Specialist 2 communicates with members, providers, and clients...assist with understanding the prior authorization process, and resolve claims processing and eligibility issues while adhering to department… more
- Zurich NA (Austin, TX)
- …workstreams + Experience in a transactional, operational or customer service environment + Quality auditing experience + Knowledge of the insurance industry and ... Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am...continuous process and system enhancements to improve operational efficiencies, quality and/or timeliness. At Zurich North America Claims… more
- Elevance Health (Houston, TX)
- …at least one of the following: AA/AS or minimum of 15 years of experience in claims auditing , quality assurance, or recovery auditing . + Requires at ... spending. The **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid...and generate audit findings letters. + Validates accuracy and quality standards as set by audit management for the… 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 ... auditing inpatient medical records and generating high quality recoverable claims for the benefit of...Health Information Technician and/or CCS as a Certified Coding Specialist and/or CIC as a Certified Inpatient Coder. +… more
- Elevance Health (Houston, TX)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing , quality assurance, or clinical documentation improvement, and a ... The **Diagnosis Related Group Clinical Validation Auditor-RN** is responsible for auditing inpatient medical records to ensure clinical documentation supports the… more
- Molina Healthcare (Houston, TX)
- …review, medical claims review, long-term services and supports (LTSS), claims auditing , medical necessity review and/or coding experience, or equivalent ... appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for auditing medical records to ensure accurate coding and compliance with regulatory ... requirements. This role ensures continuous quality improvement in coding practices while maintaining compliance with healthcare laws and organizational policies. The… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …substituted with experience on a one-to-one basis Preferred Experience Coding, auditing or quality assurance review experience. Bilingual (English/Spanish) ... and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with… more