9 crc benefits jobs found in Fort Worth

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency:  English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: The incumbent is responsible for investigating, evaluating, negotiating, and resolving personal lines property claims. Responsible for adjusting major and complex losses in their entirety, but may also adjust standard losses. ESSENTIAL DUTIES AND RESPONSIBILITIES Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not...

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 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 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.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and...

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: Collect supporting data and analyze information to make decisions regarding accuracy of billing Appropriately document work and final conclusions in designated computer program Understanding of Surgical Implants Understanding of CERiS systems and Data Base informatics Capability to meet department expectations and standards Be a team player working with Leadership Team(s) within a positive team environment 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: Exceptional organizational, strategic and critical...

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...

Position Summary:   The  Personal Lines Insurance Senior Account Manager will be responsible for managing client’s current insurance coverages, marketing new and renewal business, and rounding out client accounts. In addition to client relationships, an Account Manager also maintains positive relationships with internal and external stakeholders. Supervisory Responsibilities:   None Essential Tasks: Assisting the Personal Lines Sales Producer in maintaining the client's insurance policies Acts with independent discretion and autonomy. Attends client meetings and influences decision-making on behalf of the insured. Represents the firm in a professional manner through appearance, communication style, and demeanor Preparing endorsements to send to the insurance carriers  Assisting with cancellations of policies Educates clients about coverages and make recommendations as needed to meet client insurance needs Handles renewals and remarkets as needed. Develop...

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position includes a moderate volume of inbound calls and a high volume of outbound calls. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receive incoming calls, emails and faxes from the Medical Access Assistant line Communicate clearly and professionally with providers and other stakeholders via phone and email Provide excellent customer service...

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...