- Elevance Health (Houston, TX)
- … chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement… more
- Elevance Health (Grand Prairie, TX)
- … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… 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 ... and validating source data needed to build chart retrieval chase lists for medical record collection. Success in this role requires a blend of strong technical… more
- Sedgwick (Irving, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- UIC Government Services and the Bowhead Family of Companies (San Antonio, TX)
- **Overview** MEDICAL CLERK - (BAMC-2025-23675): Bowhead seeksMedical Clerks to support various departments at the Brooke Army Medical Center (BAMC) in San ... liability, or other designated insurance coverage. + Use knowledge of medical terminology, clinic standard operating procedures, and various appointment templates to… more
- Wells Fargo (Irving, TX)
- …AVP as part of our Chief Operating Office (COO) / Shared Services Operations (SSO) Audit Innovation & Analytics team. The COO/SSO Audit team provides coverage of ... properties, corporate security), enterprise complaints and remediation, fraud and claims management, control executive, regulatory & policy affairs, and strategic… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …ready, oversee clinical trial and submission support, lead the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity. ... sites, and vendors (including contract research organizations) and ensure that audit results are communicated, and appropriate corrective actions are implemented and… more
- Sedgwick (Houston, TX)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Elevance Health (Houston, TX)
- …Specialist Lead** is responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to ... cash receipts, cash application, claims audits, collections, overpayment vendor validation, and ...collecting samples each month from each Recovery Specialists to audit for Quality. + Distributes work to staff 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 ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more