12 director of carrier relations jobs found in Fort Worth

The Procurement Team Lead position is 50% production and 50% assisting and supporting direct supervisor with ensuring the team meets protocol, as well as performing supervisory duties during the supervisor's absence. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Monitor/Audit and reports for Procurement and clients Monitor/Audit files in Procurement staffs individual service queues via Management Console Tool for accuracy and timely claim processing Assist with Procurement QC queue tickets during high volume times Assist team members with all questions and concerns Answer emails and phone calls from both Procurement and other internal departments and also externally from Clients/Providers regarding any claims processing concerns Additional duties as assigned   KNOWLEDGE & SKILLS: Exceptional organizational skills Ability to work independently and in a team environment Ability to work in a fast paced/production...

Location(s) Fort Worth, Texas Details Kemper is one of the nation’s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper’s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises. Role: Life Insurance Sales Agent Employment Type:  Full-Time with Benefits   Work Arrangement:  Field Role Career and Opportunity Kemper is a diversified insurance holding company that has been in business for over 100 years. We are firmly committed to serving the insurance needs of modest-income...

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 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...

The Senior Director of Product Development & Management is responsible for leading the strategy, execution, and lifecycle management of cross-functional products in medical cost containment. This role ensures alignment with CERIS’ annual strategic objectives while addressing evolving industry needs. The Senior Director serves as a subject matter expert within their vertical segments, possessing relational, tactical and technical expertise in payment integrity across the industry. The leader in this role is accountable for driving product growth, with a focus on enhancing revenue generation and elevating client satisfaction. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Develop next generation services supporting strategic initiatives with prepayment and post payment solutions Grow product relationships throughout CERIS/CorVel, including but not limited to, corporate marketing, IT, regional offices, external clients, and all AE and AM staff...

The Senior 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 role 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 of...

The hospital bill audit nurse supervisor will maintain a positive team building approach with emphasis on overseeing the day to day functions of hospital bill audit nurses, reporting, leadership and professional communication with all CERiS departments.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Utilize nursing education, experience and industry best practices to lead a team of registered nurses to plan, execute and deliver timely and accurate hospital bill audits Ensure accuracy of audits through acquired knowledge of client policies, provider contract information, and other standard guidelines Assist in the development and support of auditors to meet and exceed productivity requirements based on CERiS productivity standards Act as a point of contact to answer and resolve auditor issues with the goal of providing excellent customer service and relationship management  Perform audits as necessary Keep manager informed of any issues...

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 Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Take inbound calls and makes outbound calls as needed. Analyzes client and provider inquiries to determine appropriate steps for resolution. Performs review of claim history to ensure accurate information is communicated to internal and external customer. Works directly with internal departments and management for resolution of Customer Service inquiries. Able to accurately communicate CERIS findings to clients and providers in written and verbal format. Maintain reports and spreadsheets as needed. Additional duties as assigned.   KNOWLEDGE & SKILLS:  Excellent communication, verbal, written and organizational skills. Prior knowledge of...

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...

Company: Marsh McLennan Agency Description: JOB TITLE:                     Director, Loss Control REPORTS TO:               Regional Director, Loss Control SUMMARY: The Director, Loss Control is assigned the task of providing loss control expertise and services to the Agency and Agency personnel as well as current and prospective clients.  This position has the responsibility of evaluating, developing, coordinating and implementing the specific functions of the department. ESSENTIAL RESPONSIBILITIES: Develop relationships with clients and assist in establishing, implementing and completing long-term control/risk management goals. Manage and coordinate loss control services between the client and the insurance carrier(s) to maximize loss control engineering services customized to meet the clients’ specific needs. Organize joint efforts of client, Agency and the insurer to analyze, implement and monitor safety, health and fire protection issues. Establish...