Medicaid Claims Auditor I - Reimbursement & QA
Cook Childrens
Cook Children's in Fort Worth, TX is seeking a Claim Auditor I to audit behavioral and medical claims for Texas Medicaid and CHIP, ensuring payment integrity, coding accuracy, and compliance with regulatory standards. The role includes post-claims reviews, monthly sampling for routine to moderate complexity, and pre-auditing high-dollar claims. Strong organizational, problem-solving, and customer service skills are essential, with Associates degree or 5+ years of claims/audit experience #J-18808-Ljbffr Cook Childrens
- ...Claim Auditor I Location: Calmont Operations Building Department: Reimbursement Analysis Shift: First Shift (United States of America) Standard Weekly Hours: 40... ...claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor I is responsible...ReimbursementClaimsWork at officeShift workDay shift
- ...repricing processes Develop and implement QA policies and procedures Monitor... ...SKILLS Strong understanding of repricing claims processing, and contractual rate application... ...Knowledge of healthcare revenue cycle and reimbursement Knowledge of applicable regulations and...ReimbursementClaimsMinimum wageFull timeWork at officeLocal areaRemote workFlexible hours
- ...supply sales. Receives and processes patient reimbursement information from patients, physicians,... ...and services to ensure clean claims. Job Responsibilities ~20% Acts as... ...claims. ~ Submits appropriate paperwork to Medicaid and managed care organizations (MCO) for...ReimbursementClaims
$70.14k - $107.25k
...Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG... ...Conduct audits to ensure accurate reimbursement and identifying potential savings Demonstrated... ...regulations, including Medicare and Medicaid Understand and comply with all...ReimbursementMinimum wageFull timeWork at officeLocal areaFlexible hours$68.57k - $104.84k
...DRG Quality Control/Clinical Auditor CERIS in Fort Worth, TX is seeking a DRG Quality... ...Conduct audits to ensure accurate reimbursement and identifying potential savings Review... ...regulations, including Medicare and Medicaid Understand and comply with all internal...ReimbursementMinimum wageFull timeWork at officeLocal areaRemote workFlexible hours- Payment Integrity Analyst III - QA Analyst Job Category : CERIS Requisition Number :... ...is accurately reviewing pre and post pay claim audits based on client, policy, industry... ...understanding of healthcare revenue cycle and claims reimbursement Proficient in Microsoft Office including...ReimbursementClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote workFlexible hours
$160.3k - $297.7k
...Associate Director, Access & Reimbursement (ADAR) — field-based role. Major accountabilities... ...executives, providers, billing/coding, claims, and revenue cycle managers. Analyze... ...understanding of Commercial, Medicare, and state Medicaid in the region. Preferred: ~...ReimbursementClaimsLocal area- ...maintaining an ongoing collective knowledge of HMO, PPO, Medicaid, Medicare, and commercial insurance reimbursement rates and criteria, evaluating plans to calculate... ...pertinent information needed to submit a "clean" claim when/ if charges occur during/ after visit.High...ReimbursementClaimsWork at officeLocal areaFlexible hours
$160.3k - $297.7k
...Remote The Associate Director, Access & Reimbursement (ADAR) is a field-based role that proactively... ...and coding education (as needed), claims processing, reimbursement, and integration... ...payers, Medicare plans and state Medicaid in geographic region.Must live within assigned...ReimbursementClaimsFull timeWork at officeLocal areaRemote work- CorVel Corporation is seeking a Provider Management Analyst to verify provider information and audit documentation for claims, including itemized bills, medical records, UB04s, and HCFAs. This remote role emphasizes accuracy and timely processing. You will collaborate...ClaimsRemote job
- CorVel Corporation, CERIS division, seeks a Provider Management Analyst to verify provider information and documentation for claim audits, including itemized bills and medical records. This is a remote position. Responsibilities include communicating with leadership, maintaining...ClaimsRemote job
- ...of the grade for which you are selected. Basic Requirements for Auditors You must have either A or B: A. Degree: accounting, auditing;... ...transcript will be required prior to appointment. Additionally, if you claim to meet the basic requirements under option B2 or B3 as...ClaimsContract workWork at office
- ...seeking an experienced, organized, and motivated Personal Injury Claims Manager to join our team and take ownership of the day-to-day... ...insurance, medical liens, letters of protection, and other reimbursement claims. Assist with reductions and negotiations of medical bills...ReimbursementClaimsFull timeWork at office
$71k - $73k
...to hear from you. The Supervisor, CGT Reimbursement & Medical Benefit Operations is responsible... ...medical billing teams to ensure claims are billed accurately and compliantly.... ...regulations, including HIPAA, Medicare, and Medicaid guidelines. Exceptional written and verbal...ReimbursementClaimsWork at officeRemote work- ...Calmont Operations Building Department: Reimbursement Analysis Shift: First Shift (United States... ...payment integrity by executing a claim recovery strategy, which includes the analysis... ...that claims process in compliance with Medicaid guidelines for the State of Texas and Health...ReimbursementClaimsContract workShift workDay shift
$30k - $50k
...Responsive recruiter Replies within 24 hours Benefits License Reimbursement Bonus based on performance Competitive salary Flexible schedule... ...with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with...ReimbursementClaimsWork at officeFlexible hours- ...Billing and Coding Specialist do? A medical billing and coding specialist processes and codes healthcare claims to ensure accurate billing and insurance reimbursement, supporting the financial operations of healthcare facilities. Highlights : Complete in as short...ReimbursementClaims
- ...sales. Receives and processes patient reimbursement information from patients, physicians,... ...information and services to ensure clean claims. Job Responsibilities : -20% Acts... ...claims. -Submits appropriate paperwork to Medicaid and managed care organizations (MCO) for...ReimbursementClaims
- ..., and event venues. Position Summary The Lot Attendant / Lot Auditor helps ensure a smooth, safe, and organized parking experience... ...phone for work-related communications or to access mobile apps. Reimbursement will follow company policy when applicable. Pay Transparency...ReimbursementHourly payMinimum wageFull timePart timeLocal areaShift workNight shift
- ...follow-up, analysis, and resolution of outstanding insurance claims; initiation of the appeals process on behalf of CCPN providers... ...will primarily be responsible for performing duties such as; reimbursement analysis; provides the Manager, Insurance Follow-Up & Denials...ReimbursementClaimsWork at office
- Cook Children’s in Texas seeks a Systems Reimbursement Analyst to maintain payment integrity by analyzing claims data to identify cost containment opportunities and auditing provider contracts for proper claim payments. The role supports delegation processes across lines...ReimbursementClaimsContract work
- Liberty Mutual Insurance seeks a Field Property Claims Adjuster to help customers navigate the claims process after property damage... ...program, work in the field daily, and may be eligible for mileage reimbursement and a company-provided vehicle after meeting mileage...ReimbursementClaims
$71k - $73k
McKesson is seeking a Supervisor for CGT Reimbursement & Medical Benefit Operations. Hybrid role near Fort Worth, TX or Cary, NC. Lead a team... ...benefit specialists, drive performance, and ensure compliant claims processing across Cell & Gene Therapy programs. The role...ReimbursementClaims- CorVel Corporation is seeking a Revenue Cycle Specialist to analyze and monitor claims audit data across multiple platforms, ensuring accurate reimbursement and resolving variances with internal and external partners. The role requires strong knowledge of claims processing...ReimbursementClaimsRemote jobWork at office
- ...with the Federal Information Security Management Act (FISMA). The auditor participates with other audit staff members in performing audits... ...will be required prior to appointment. Additionally, if you claim to meet the basic requirements under option B2 or B3 as outlined...ClaimsFull timeContract workWork at officeRemote workRelocation
$58.7k - $70k
...(MBA), Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), or another... ...pediatric and family building support, adoption and surrogacy reimbursement, and dependent care spending account (with employer match)....ReimbursementFull timeH1bWork at officeRemote workRelocation package1 day per week- CLA is seeking a Healthcare Reimbursement Director for its Dallas-Fort Worth or Houston offices in Texas. The role focuses on Medicare and Medicaid cost reports and related consulting within the Healthcare Group, serving hospitals, health systems, and other facilities....Reimbursement
- ...Associates, the Benefit Advocate manages eligibility, billing, and claims inquiries, and provides day-to-day support and education that... ...benefit selection, including matching 401k Gym membership reimbursement Hotchkiss is an EOE and drug-free workplace. All applicants...ReimbursementClaimsWork at office
- ...relationships with key stakeholders and Nobility Clients Monitor the claim adjudications; identify the trends and recommend actions to... ...practice management, and insurance company claims filing and reimbursement practices - required. An understanding of CPT, ICD-10 and...ReimbursementClaimsWork at officeLocal areaMonday to Friday
$120k - $150k
...$120,000 - $150,000 PLUS as a realistic year one. ~ Expense reimbursement ~ Full benefits package including health care, 401K, paid time... ...regarding the products they offer and how they handle claims. We accomplish this by creating customized, wealth-building purchase...ReimbursementClaimsImmediate start
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