- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Providence (TX)
- …and retain the best people, we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims and ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Conduent (Dallas, TX)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Molina Healthcare (Houston, TX)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
- Zelis (TX)
- …This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, ... We are seeking a detail-oriented and technically skilled analyst to support healthcare claims repricing and data validation efforts. In this role, you will be… more
- CRC Insurance Services, Inc. (Flower Mound, TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- CRC Insurance Services, Inc. (TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Trustmark (Austin, TX)
- …communities. **About the role** This role is a dedicated training position for Claims that resides in the Knowledge Management & Customer Experience group. The ... primary function of this role is to train and audit new and existing staff in all products including...claim handling process and procedures and experience in handling claims appropriately in accordance with the corporate claim philosophy,… more
- Elevance Health (Houston, TX)
- …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
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