26 senior auditor jobs found in Fort Worth

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...

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 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...

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...

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   Contract role:     About the role:  Benefits Administration & Operations Administer employee benefit programs including medical, dental, vision, life, disability,...

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 PPI Coordinator plays a key role in supporting the Policy and Payment Integrity teams by managing workflow, ensuring timely assignment of appeals, and maintaining accurate tracking systems. This position required strong organizational skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. This is a remote position. Essential Functions & Responsibilities: Manage and monitor general PPI department mailboxes to ensure timely review and routing of incoming correspondence Assign appeals to appropriate team embers based on established workflows and production needs Maintain and update appeal trackers to ensure accurate and current data is available for reporting and performance monitoring Track the status of assign appeals to support timely completion and compliance with internal expectations and external deadlines Identify workflow delays or discrepancies in tracking systems and escalate to leadership as...

Why Global Procurement at GM Financial? Do you excel at building and maintaining critical relationships, enjoy strategic sourcing, and are a successful negotiator? If so, then GM Financial Global Procurement Department is the place for you. Global Procurement at GM Financial is a strategic, high-impact team that manages sourcing, contracts, and supplier relationships across the organization. You’ll work with advanced processes, tools, and policies to drive efficiency and innovation, while collaborating with business units and suppliers worldwide. The role offers opportunities for professional growth, leadership, and exposure to diverse procurement operations, making it an ideal environment for those seeking to deliver value and shape the company’s future. 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:...

Position Summary:   The Account Manager position maintains a professional relationship with our clients through exceptional customer service.  Account Managers are assigned a book of business comprised of fully insured and level funded clients in our Small Business Unit. This role is responsible for obtaining clients’ trust by meeting their needs and expectations. They are also responsible for supporting our sales Agent(s) in producing new business and renewing existing business.  Account Managers serve as an advocate to our clients and their employees through positive relationships with the various carriers and continuous education. Supervisory Responsibilities:   None Essential Tasks: Acts as the primary contact between client, prospect, agency, and producer; represents the agency in handling complaints, arbitrating disputes, or resolving grievances Handles or refers all service requests by our clients Initiates and handles marketing of accounts beginning 120 days...

Why Regulatory Compliance Examination Manager at GM Financial?  The Regulatory Compliance Examination Manager role offers a unique opportunity to make a meaningful, enterprise wide impact. As the leader overseeing federal and state examination activities, this position plays a central role in shaping how the organization demonstrates compliance and manages regulatory risk. The work is highly visible and influential, involving regular collaboration with senior executives, Legal, Internal Audit, Analytics, and business partners across the enterprise. You will guide the full exam lifecycle, strengthen controls, and drive impactful process and system enhancements. This is an ideal role for a leader who wants to shape compliance strategy, enhance organizational readiness, and play a critical part in advancing the company’s regulatory posture. At GM Financial, our team members define and shape our culture — an environment that welcomes innovative ideas, fosters integrity, and creates...

Position Summary:   The Employee Benefits Unit Supervisor, Account Management Small Business Unit, is responsible for overseeing assigned team, under the direction/mentorship of the Employee Benefits Leader, including workflows, new business/renewal assignments to staff, ensuring adherence to agency procedures by staff, serves as liaison between producers and team staff;   also responsible for conflict resolution and disciplinary correction in tandem with the team leader   Supervisory Responsibilities:   ·          Participate in interviewing and evaluation of prospective employees ·          Providing training and guidance regarding department procedures ·          Participating in disciplinary and termination issues ·          Ensuring compliance with policies and procedures ·          Implementing new procedures and/or changes ·          Ensuring smooth and efficient operation of department ·...

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 work independently...

The Personal Lines Client Service Manager is responsible for assisting producers and clients in maintaining insurance coverage for personal lines of insurance to include processing and invoicing policies, endorsements, audits, and cancellations. Supervisory Responsibilities:   None Essential Tasks:  Preparing and processing endorsements requests for submission to insurance carriers, including invoicing, and timely follow-up to confirm receipt. Verification of rates, exposures, and prior premiums to ensure accurate policy records. Handling/processing policy cancellations, billing inquiries, and related issues with attention to detail and efficiency. Work closely with Senior Insurance Managers for the review and approval of endorsements and renewals. Provide exceptional client service and support policy retention efforts through proactive communication and problem-solving. Respond to and process certificate of insurance (COI), ID Cards, and billing questions as...

Position Summary: The Account Coordinator provides administrative support to internal account managers and maintains a professional relationship with our external clients. Supervisory Responsibilities: None Essential Tasks: • Conducts data entry into Excel spreadsheets, internal agency management system, carrier websites, House Bill requests • Assists in marketing of accounts as directed by account managers • Assists with the preparation of reports, proposals and other presentation materials • Audits billing statements for accuracy on behalf of clients • Generates open enrollment materials such as enrollment guides, election forms, personalized confirmation sheets, enrollment/change forms, etc • Assists in processing necessary paperwork for submission to carrier –implementation • Attend local enrollment/client meetings as needed • Delivers outstanding customer service • Maintains agency files accurately and consistently • Attends and completes any training sessions or assignments...

Position Summary:   The Commercial Lines Account Manager   provides prompt, accurate and courteous service to our clients, producers and company personnel, while offering a high level of support in obtaining, maintaining, expanding and servicing our commercial accounts. Supervisory Responsibilities:   None Essential Tasks: Collectively plans, designs and implements appropriate insurance programs for clients that coincide with agency guidelines Maintains knowledge of new developments or changes with various carriers and new Federal/State laws that may affect how our clients conduct business; consults, informs and educates clients about coverage, exclusions and exposures: documents electronic filing accordingly Generating premium allocations for clients; advanced Microsoft Excel proficiency Negotiating rate terms and conditions with Carriers on behalf of clients Provides technical support to Producers (coverage-wise, with proposal, suspense items, etc.) Prepares...

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...

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 role is responsible for independent scheduling requiring flexibility and travel to provider location.    This is a remote position with travel required. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Acknowledge assigned work, 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, unbundled items, errors,...

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 IT Compliance Analyst supports the organization’s compliance and risk management programs by coordinating assessments, audits, and certifications across frameworks such as HITRUST, SOC, HIPAA, and NIST. This role helps maintain a strong IT compliance posture by managing evidence, monitoring control performance, maintaining documentation, and partnering closely with IT, Security, Privacy, Legal and external auditors. The Analyst also contributes to continuous improvement efforts, compliance automation initiatives, and reporting that supports leadership visibility and informed decision-making.   Key Responsibilities Assessment & Audit Support Coordinate internal and external compliance assessments, audits and certifications. Prepare, organize, and manage evidence to meet control and audit requirements. Track remediation activities and ensure timely closure of identified gaps. Maintain audit-ready documentation and support readiness reviews. Additional...