- Houston Methodist (Sugar Land, TX)
- …efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals and contract ... making, active patient and family participation in treatment/care planning and health promotion. + Generates reports to identify trends and opportunities for… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …with Sales and Marketing on sample allocation and planning. + Support audit readiness and compliance reviews. **Operational Efficiency & Field Partnership** + ... fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive… more
- New Jersey Resources (Houston, TX)
- …culture that mitigates and manages risk. Proactively identify environmental, health , safety and wellness, and compliance-related risks, opportunities, trends, and ... (eg FERC, PHMSA, PADEP, MDEQ and MSOGB). Ensure compliance with occupational health and safety laws and regulations, company policies and operating procedures.… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Resolution team handles all complaints for Humana, including formal grievances, appeals, ... operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes… more
- 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 ... period each month for those patients on employer Group Health Plans to ensure Medicare will be in place...caseloads; Analyzes patient reports from billing systems as an audit check to ensure the correct insurance information is… more
- Verint Systems, Inc. (Austin, TX)
- …programs, including health insurance, retirement plans, and other benefits + Audit benefits data, costs, and utilization to identify areas for improvement and ... and effectively respond to escalations regarding benefit programs or claims issues + Conduct audits on benefit enrollments and...and employee deductions as needed to ensure accuracy + Audit , review and process all benefit invoices + Assist… more
- Mass Markets (Killeen, TX)
- …are administered fairly and consistently throughout the area of responsibility + Perform audit and compliance functions as requested on items such as audit ... ranging from electronics to dream vacations-and sometimes even cars! + Health Benefits: Full-time employees are eligible for comprehensive medical, dental, 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
- 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
- University of Texas Rio Grande Valley (Harlingen, TX)
- …billing rules and government regulations. Provides feedback and education related to audit results. * Reviews documentation by physicians and clinical staff as well ... billing/collection staff to ensure accurate physician reimbursement is achieved and claims denials are reduced by ensuring documentation integrity. * Educates all… more