- Truist (Dallas, TX)
- …In-depth understanding of compliance in regulated industries (eg, financial services, healthcare ). Experience working with audit and risk management processes. ... **Stakeholder Engagement & Communication:** Facilitate collaboration between application, infrastructure, and business teams to drive efficiency and innovation. Demonstrated ability to partner with line-of-business leaders, security teams, and developers to… more
- Molina Healthcare (San Antonio, TX)
- …contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles ... support regulatory and clinical compliance. **Knowledge/Skills/Abilities** + Support RADV audit execution by identifying appropriate data sources, validating CMS … more
- Molina Healthcare (Houston, TX)
- …and other guidance to assess compliance and support building regulatory compliance audit procedures. * At the direction of management, performs oversight audits and ... with developing the Operational Oversight Work Plan, monitoring and reporting status of audit project tasks, and reporting on overall status of audit projects.… more
- Molina Healthcare (Houston, TX)
- …Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure ... schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit… more
- Molina Healthcare (San Antonio, TX)
- …Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other ... decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides… more
- Molina Healthcare (San Antonio, TX)
- …and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are ... met * Evaluate results from audit activities to address barriers, gaps, opportunities for improvement,...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (TX)
- …COB and TPL processing logic. + Assist in developing and refining internal SOPs and audit tools related to COB claim reviews. + Act as subject matter expert for ... + Assists manager in establishing standards, guidelines, and best practices for the audit team + Interprets and validates accuracy of complex reports and automated… more
- UGI Corporation (Houston, TX)
- …basis. Nearest Major Market:Houston Job Segment: Pipeline, Supply, Substance Abuse, Behavioral Health, Internal Audit , Energy, Operations, Healthcare , Finance ... when necessary. + Execute all supply related requests pertaining to the internal audit by providing the needed documentation and sharing knowledge of the supply… more
- Amazon (Austin, TX)
- Description Amazon is making bold investments to reshape healthcare delivery by making it more accessible, efficient, secure and compliant. We are seeking a highly ... experienced Senior Healthcare Compliance Specialist to join our dynamic team and...informed decisions. Risk Mitigation: Spearhead innovative risk assessment and audit methodologies to identify vulnerabilities and develop advanced strategies… more
- Molina Healthcare (Austin, TX)
- …while collaborating with other teams. * Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing ... solutions to maximize national HEDIS audit success. * Partner with other teams to ensure...running queries in Microsoft Azure or SQL server * Healthcare experience and functional risk adjustment and/or quality knowledge… more