- WTW (Houston, TX)
- **Description** As a Medical Claim Lead Auditor , you will apply your audit, project management and client management skills to lead client audits. ... Develop working relationship with vendor counterparts + Distribute individual claim /work queues to team in a timely manner +...Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical ,… more
- Elevance Health (Grand Prairie, TX)
- …strongly preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, ... granted as required by law._ The **DRG Clinical Validation Auditor ** is responsible for auditing inpatient medical ...but are not limited to: + Analyzes and audits claims by integrating medical chart coding principles,… more
- Elevance Health (Grand Prairie, TX)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... **Clinical Provider Auditor II** **Location** : We prefer any of...may include, but are not limited to: + Examines claims for compliance with relevant billing and processing guidelines… more
- Elevance Health (Grand Prairie, TX)
- …and medical policy guidelines strongly preferred + BA/BS preferred + Medical claims review with prior health care fraud audit/investigation experience ... **Nurse Auditor Senior - Payment Integrity Complex and Clinical...impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and… more
- Humana (Austin, TX)
- …part of our caring community and help us put health first** The Risk Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and ... to evaluate business processes and drive improvements aimed at minimizing risk. The Lead will focus on Project Management and is responsible for oversight of the… more