- Molina Healthcare (Houston, 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
- Elevance Health (Grand Prairie, TX)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... submitted DRG. **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in… more
- Highmark Health (Austin, TX)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Baylor Scott & White Health (Dallas, TX)
- …individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core ... issues. Develops relationships with internal and external physicians, administrators, healthcare delivery system leaders, and other stakeholders to strengthen and… more
- Highmark Health (Austin, TX)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Humana (Austin, TX)
- …for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must be able to work core business hours on EST time between ... Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This… more
- City of College Station (College Station, TX)
- …dependent verifications, earnings and deductions administration; billing/invoicing; claims reviews; system administration, vendor audits and reconciliations, ... to ensure reasonable responses to employee concerns, resolution of issues related to claims or service disruptions, and to confirm accuracy in the application of… more
- CACI International (San Antonio, TX)
- …verify payment histories and invoice statuses. + Collaborate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA) to confirm ... audit status and final project acceptance. + Request and...CO approval, including draft DD Form 1594s, release of claims , and other necessary paperwork. + Input contract obligations… more
- CACI International (San Antonio, TX)
- …through various other information systems; + Coordinate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA), if applicable to ... verify audit status, and/or final project acceptance by the Government;...writing system, preparing draft DD Form 1594s, release of claims , memos for record, and any other documentation deemed… 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** + ... requirements related to pharmaceutical samples. **Preferred:** + Pharmaceutical or healthcare industry experience. + Experience with fleet management platforms or… more