- Highmark Health (Austin, TX)
- …or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated funds paid ... for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into… more
- Baylor Scott & White Health (Dallas, TX)
- …regularly with Health Plan operations on network configuration, provider data and audit function (the provider data integrity unit). This position could be based ... practices. - Leads the development and implementation of an audit program that resolves issues and errors and adjusts...consistency between contract terms and adjudication of authorizations and claims . - Plays a critical role in overseeing pricing… more
- Robert Half Accountemps (Garland, TX)
- …a medical or healthcare setting is a plus). + Familiarity with medical billing, insurance claims processing, or accounts reconciliation highly desirable. + ... to join our on-site accounting team in the dynamic medical industry. The ideal candidate will play a vital...with insurance companies and billing teams regarding payments or claims . General Accounting Support: + Assist in maintaining and… more
- Robert Half Accountemps (Dallas, TX)
- …Basic understanding of medical coding practices (eg, CPT, ICD-10) and insurance claims processes is a plus. + Attributes: + Exceptional attention to detail and ... an experienced and detail-oriented Bookkeeper to oversee financial operations within our medical organization. As a Bookkeeper, you will play a critical role in… more
- Elevance Health (Grand Prairie, TX)
- …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical… more
- ManpowerGroup (Houston, TX)
- …Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third ... Health Plan metrics, policies, regulations, and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from… more
- CACI International (San Antonio, TX)
- …Air Force bases in the continental United States, also supporting Air Force medical contracting, the Air Force Civil Engineering Support Agency and the Defense ... through various other information systems; + Coordinate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA), if applicable to… more
- EMCOR Group (Manchaca, TX)
- …systems for semi-conductor manufacturers, high-tech fabrication, pharmaceutical companies, medical complexes, and other highly specialized facilities. **SUMMARY** ... with Purchasing Manager for inclusion of terms and discounts. + Coordinate claims issues and legal activity with EMCOR Construction Services legal counsel by… 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** + ... with states and local laws. **Company benefits** : Comprehensive medical , dental, vision, prescription drug coverage, company provided basic...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Molina Healthcare (San Antonio, TX)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and...+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager… more