34 clerical jobs found in Fort Worth

Why GM Financial? GM Financial is the wholly owned captive finance subsidiary of General Motors and is headquartered in Fort Worth, U.S. We are a global provider of auto finance solutions, with operations in North America, South America, and the Asia Pacific region. Through our long-standing relationships with auto dealers, we offer attractive retail financing and lease programs to meet the needs of each customer. We also offer commercial lending products to dealers to help them finance and grow their businesses.   At GM Financial, our team members define and shape our culture — an environment that welcomes new ideas, fosters integrity, and creates a sense of community and belonging. Here we do more than work — we thrive.   Our Purpose: We pioneer the innovations that move and connect people to what matters  About the role:  Serve as first point of contact to respond to basic HR Service Center inquiries related to benefits coverage, leave of absence policies and...

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through...

The Diagnostic Related Groups (DRG) Clinical 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 Completes DRG audits as needed Responsible for the overall integrity of the quality of diagnosis and...

CERiS in Fort Worth, Texas is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) QC Clinical Auditor will be responsible for performing quality control DRG validation (clinical/coding) reviews of internal audit team 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 records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination, as well as communicating missed or incorrect information to the auditors in a professional manner. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. This is a remote position. Job Duties and Responsibilities: The Quality Control...

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 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 determine accuracy of billing through...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & 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 Use 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, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...

The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determines validity and compensability of the claim using CorVel proprietary programs Makes recommendations and communicates claim status to to 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 Maintain HIPAA compliance Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and understanding of claims practices Strong organizational skills Ability to meet or...

The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider appeals. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and appeals. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.  This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Supervises all daily activities of payment integrity team related to quality assurance and provider appeals Ability to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERIS Ability to...

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 identify...

The Itemization Review Team Lead provides support for the Itemization Review Supervisor while working with IBR team and CERIS internal departments.    ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Maintains Q&A support for the IBR Team Effectively works with coordinator and internal departments for consistency and accuracy of departmental processing needs Collects supporting data and analyzes information to make decisions regarding accuracy of billing Appropriately documents work and final conclusions in designated computer program Meets department's expectations and standards  Additional duties as assigned   KNOWLEDGE & SKILLS: Understanding of Itemization Review for designated clients Understanding of CERIS systems and Data Base informatics Understanding of HIPAA regulations Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly Demonstrated leadership skills; ability to work with...

The Closing Team Lead is responsible for monitoring and tracking all closing processes. This role runs queries, maintains reports, and supports the trainers while keeping up with the training material. The Closing Team Lead may assist supervisors with additional projects/tasks. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Run queries to collate data; maintain reports and Excel spreadsheets as needed Monitor and track completion of files and special tasks Oversee the training for all new Closing Analysts Responsible for keeping training material up to date Assist Team of Closing Analysts with questions and escalations Required to close files when needed Serve as a final Quality Control for Closing Analyst files as needed Track analyst errors and create coaching measures Lead meetings and conduct presentations as needed Additional duties as assigned   KNOWLEDGE & SKILLS:...

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receiving and analyzing appeal documentation to determine appropriate actions Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards Utilize applicable tools and resources to complete setup Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of Medicare, Medicaid, and commercial insurance guidelines...

The CERIS Operations Supervisor is responsible for managing daily production for the department, which may include one or more of the following functions:  human resources, customer service, and promoting positive mentorship for the team. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Accountable for maintaining highest quality of service Handle human resources matters directly related to employees supervised Maintain employee confidence and protect operations by keeping sensitive information confidential May be required to travel overnight to attend meetings May perform daily, weekly and monthly reviews of various reports, invoices, logs and expenses Approve Electronic time cards for employees Assist Manager in establishing employee schedules  Oversee quality control and tracking or error rates Maintaining HIPAA compliance in all aspects of...

The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collects supporting data and analyzes information to make decisions regarding accuracy of billing Appropriately documents work and final conclusions in designated computer program Understanding of Surgical Implants Meets department's expectations and standards  Additional duties as assigned   KNOWLEDGE & SKILLS: Understanding of Itemization Review for designated clients Understanding of CERIS systems and Data Base informatics Understanding of HIPAA regulations Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly Demonstrated leadership skills; ability to work with Leadership Team(s) within a positive team environment...

The CERIS Operations Supervisor is responsible for managing daily production for the department, which may include one or more of the following functions:  human resources, customer service, and promoting positive mentorship for the team. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Accountable for maintaining highest quality of service Handle human resources matters directly related to employees supervised Maintain employee confidence and protect operations by keeping sensitive information confidential May be required to travel overnight to attend meetings May perform daily, weekly and monthly reviews of various reports, invoices, logs and expenses Approve Electronic time cards for employees Assist Manager in establishing employee schedules  Oversee quality control and tracking or error rates Maintaining HIPAA compliance in all aspects of...

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 & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to...

The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determines validity and compensability of the claim using CorVel proprietary programs Makes recommendations and communicates claim status to to 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 Maintain HIPAA compliance Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and understanding of claims practices Strong organizational skills Ability to meet or...

The Correspondence Department 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 reporting to Fort Worth, TX. 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...

The Implementation Manager will be responsible for enhancement to existing products and development of new products to broaden current service offerings. This role will also be accountable for project management and implementation management with new and existing clients.  The primary purpose of the role is to work closely with the assigned Account Manager, Implementation Coordinators, IT, and Operations to complete the implementation of client programs and to facilitate the transition to field operations and account management personnel for ongoing servicing.   We offer a competitive salary and benefits package. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Participates in oral presentations Prepares and manages implementation plan from prospect presentation through conclusion Identifies required resources Develops and prepares information necessary for setup of customer across all CorVel systems Coordinates all internal meetings on a...