56 jobs found in fort worth

Company: Marsh McLennan Agency Description: JOB TITLE: Sr. Benefits Account Executive JOB TYPE: FLSA Exempt ESSENTIAL DUTIES & RESPONSIBILITIES: Primary Contact with the Producer Manage the Client Insurance Program, utilizing agency management system.  Generally manages small and less complex accounts than the Senior Account Consultant position.  Duties include those that are done directly (higher level) or accomplished through other resources (i.e. assigned Account Managers or external resources) and not limited to: A point of contact with the Producer. Responsible for sharing knowledge, providing instruction, and delegating tasks to the Account Manager, Call Center, Benefits Admin, Wellness and iCAF, and any team member not specifically identified,  as per Benefits Timeline. Inform Producer of upcoming deadlines and events. Maintain R: Drive/client files as per Department Guidelines. Manage “workflows” and administration as per Benefits Timeline....

Company: Marsh McLennan Agency Description: JOB TITLE: Benefits Account Executive JOB TYPE: FLSA Exempt ESSENTIAL DUTIES & RESPONSIBILITIES:  Primary Contact with the Producer Manage the Client Insurance Program, utilizing agency management system. Duties include, but are not limited to, those below: Point of contact with the Producer, informing Producer of upcoming deadlines and events Responsible for sharing knowledge, providing instruction, and delegating tasks to the Account Manager, and cross-functional departments Manage “workflows” and administration of client benefit programs, adhering to deadlines Research and answer questions regarding client benefit plans, claims billings, etc. Coordinate and/or Deliver Wellness Presentations so that client understands full scope of MMA vendor capabilities. Primary Contact with the Market Place Build and maintain vendor relationships. Manage renewal bid/RFP strategy and process. Manage ongoing...

The Diagnostic Related Groups (DRG) Clinical Audit Supervisor is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This is a remote position ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises all daily activities of the DRG Clinical Auditors Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative Required to complete DRG audits as needed Responsible for the overall integrity of the quality of...

The CERIS Operations Manager is responsible  for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure  timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible  for monitoring quality control of results per employee as well as the entire unit overall Responsible  for ensuring Metrics are in compliance daily Responsible  for tracking and reporting of department metrics to Director of...

The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines.  The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice.  Charge audits identify overcharges, undercharges, and unbundled items per payor contract and industry standards.  This candidate will be responsible for independent scheduling requiring flexibility and travel to provider location.    This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Onsite scheduling and travel – acknowledge work that is assigned, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner Travel onsite as needed to perform audits Review medical records to verify services were provided and charges are accurate – Identify overcharges, undercharges,...

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.  Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits. Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. Utilize applicable tools and resources to complete internal audits and/or appeals. Timely completion of internal audits and/or appeals. Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and...

JOB SUMMARY: The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching...

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.  Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits. Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. Utilize applicable tools and resources to complete internal audits and/or appeals. Timely completion of internal audits and/or appeals. Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and...

The CERIS Operations Manager is responsible  for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a onsite position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure  timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible  for monitoring quality control of results per employee as well as the entire unit overall Responsible  for ensuring Metrics are in compliance daily Responsible  for tracking and reporting of department metrics to Director of...

CERIS is seeking a MCS Certified Coder. The MCS Certified Coder reverse code previously coded medical bills to determine coding accuracy. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determine validity and compensability of the claim using CorVel proprietary programs Make recommendations to referring office Communicate claim status with referring office Read and comprehend all medical reports Adhere to client and carrier guidelines and participate in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties/responsibilities as assigned Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance   KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and understanding of claims...

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues.   This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims  with precision Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners. Performs contract and reimbursement variance analysis. Analyzes claims data to...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...

CERIS is seeking a DRG Coder/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures.  The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to...

The Closing Team Lead is responsible for monitoring and tracking all closing processes. Able to run quires and maintain reports. Support the trainers, including keeping up with the training material. Assist the supervisors with additional projects/task. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Run queries to collate data Monitor and track completion of files Monitor and track completion of special tasks Maintain reports and Excel spreadsheets as needed Overseer for training all new analyst Responsible for keeping training material up to date Assist analyst with questions Required to close files when needed Serve as a final QC step for analyst files as needed Track analyst errors and create corrective measures Work at home but able to come into the office as needed Able to conduct meetings Additional duties/responsibilities as assigned Comply with all safety rules/regulations, in...

The Appeals Representative is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Ability to appropriately interpret provider appeals and apply analytical thinking skills Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill Utilize applicable tools and resources to complete appeals Timely completion of appeals Additional duties as assigned   KNOWLEDGE & SKILLS: Prior knowledge of inpatient and outpatient hospital revenue cycle required Excellent written and verbal...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests. This is a remote position.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Communicates with respective leadership on any issues or problems identified. Punctual and consistent attendance required. Maintains production standards, production requirements, and quality of work. Assist coworkers, supervisor, or management to accomplish product goals and reports any potential issues in a proactive manner. Forwarding misdirected requests to the correct individual/department to respond to any requests timely. Outbound calling may be needed for specific roles. Ensure strict...

Higginbotham , a privately held, independent insurance and financial services firm that ranks within the top 20 nationwide, has an immediate opening for a Instructional Designer . Learning & Development individuals of Higginbotham should possess an extraordinary personality that represents our company and department to the inside and outside world. The Instructional Designer will ensure the efficiency and effectiveness of learning programs and will be responsible for organizing and reporting training needs and results. Essential Tasks: Participate in project teams comprised of subject matter experts and stakeholders to determine desired Learning & Development outcomes and alignment opportunities. Design, maintain, and deliver learning content and programs within designated timelines, including multiple learning delivery methods that accommodate various learning styles to maximize learning impact. Use project management systems to monitor, update, and...

About HUB HUB International is a top 5 global insurance broker providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. HUB has more than 650 offices across the United States, Canada and Puerto Rico with more than 19,000 employees. Our regional offices throughout North America are dedicated to helping individuals and businesses evaluate and manage their risks and insurance needs.  We are a company dedicated to superior customer service with employees committed to adding value to every client activity. Essential   Duties & Responsibilities Prepare side-by-side comparison spreadsheets for every renewal. We do not allow auto-renewals, as we work exclusively with high-net-worth clients. This is a manual process due to system limitations (EPIC does not pull the necessary data). Send out "red carpet" welcome emails for new clients, including policy summaries, team...

Company: Marsh McLennan Agency Description: JOB TITLE: Commercial Account Executive JOB TYPE: FLSA Exempt ESSENTIAL DUTIES & RESPONSIBILITIES: Documentation Manage the Client Insurance Program, utilizing agency management system.  As a matter of routine, manages larger and more complex accounts than the Associate Account Executive.  Duties include those that are done directly (higher level) or accomplished through other resources (i.e. assigned Account Managers or external resources) and not limited to:           A point of contact with the Producer Initiate correspondence with the marketplace Act as a contact with vendors to ensure proper processing of requests necessary to effectively maintain the client’s insurance program Maintain positive client relationship and have the ability to analyze situations, make reasonable decisions and follow-through. Begin to demonstrate a consultative ability to instruct and guide the client Manage upcoming...