25 clinical review auditor jobs found in Fort Worth, TX

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...

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...

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 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...

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   This position will be posted until filled. The Accountant II prepares journal entries, difficult and involved reconciliations, researches and resolves...

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 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 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...

Why GMF Technology?   Innovation isn’t just a talking point at GM Financial, it’s how we operate. From generative AI and cloud-native technologies to peer-led learning and hackathons, our tech teams are building real solutions that make a difference. We’re committed to AI-powered transformation, using advanced machine learning and automation to help us reimagine customer interactions and modernize operations, positioning GM Financial as a leader in digital innovation within a dynamic industry.   Join us and discover a workplace where your ideas matter, your development is prioritized, and you can truly make a global impact. Please note, this role is hybrid at our AOC 1 office in Arlington, TX (2 days onsite, 3 days remote) About this role The Global Infrastructure Data Transmission Administrator III will assist as a high-level subject matter expert in the day-to-day tasks critical to the team's success. This individual will focus on the support and implementation of...

 Why GMF Technology? Innovation isn’t just a talking point at GM Financial, it’s how we operate. From generative AI and cloud-native technologies to peer-led learning and hackathons, our tech teams are building real solutions that make a difference. We’re committed to AI-powered transformation, using advanced machine learning and automation to help us reimagine customer interactions and modernize operations, positioning GM Financial as a leader in digital innovation within a dynamic industry.   Join us and discover a workplace where your ideas matter, your development is prioritized, and you can truly make a global impact.   Please note: this is a hybrid position requiring 2 days onsite in Arlington, TX. About this role The Software Engineering Manager is accountable for the delivery and ongoing support of Commercial Lending technology solutions within a highly regulated banking environment. This role ensures that all engineering activities adhere to established...

Company Details   2025 Business Insurance Best Places to Work winner, Berkley Southwest  offers commercial property and casualty products and services through independent agents in Arizona, Arkansas, New Mexico, Oklahoma and Texas. We maintain a strong local presence in each of our markets, keeping underwriting and support close to the customer.    Now more than ever, financial strength is critical to a successful, long term insurance relationship. Berkley Southwest is a member company of W. R. Berkley Corporation , a Fortune 500 company, whose insurance company subsidiaries are rated A+ (Superior) by A.M. Best.  #LI-LD1 #LI-HYBRID   This position will be based in our Irving, TX office.   We offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so .    The company is an equal opportunity employer.       Responsibilities As a Manager,...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Representative Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:       Irving, TX : 2201 W. Royal Lane Suite 125 Irving, TX 75063   PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and...

Company Details     At Berkley Entertainment, we have over 25 years of underwriting risks in Entertainment & Sports.  Our one focus is entertainment insurance. We bring our decades of entertainment experience together to go beyond the basics, providing crafted coverage solutions to protect our clients.   Our team’s industry experience and collaborative approach leads to great client solutions — and this is by design. We are here to assist with customizing products and services that are tailored to respond to each client’s unique exposures.   The Company is an equal employment opportunity employer. Responsibilities As a Premium Auditor, you’ll play a critical role in ensuring accurate premium calculations and compliance across multiple regions. You’ll review and evaluate financial records to verify classification and exposure reporting and collaborate with internal teams to deliver precise audit results. You’ll...

Description The Note Finance Risk Analyst is responsible for ensuring the accuracy, integrity, and control of borrower data, financial calculations, and audit processes across the Note Finance portfolio. This role performs detailed reviews, identifies risks, conducts analysis, and supports the end‑to‑end execution of the Note Finance audit and sampling programs. The analyst delivers high‑quality insights, supports system improvements, and strengthens the governance of Note Finance operations. Responsibilities                 Oversee Data Integrity and Quality Control Monitor, validate, and analyze the quality and integrity of Data Tapes submitted by Note Finance Borrowers. Identify data discrepancies, anomalies, and integrity issues; initiate corrective actions and ensure timely resolution. Maintain documentation of findings and collaborate with internal and external stakeholders to enhance data...

About Us  We’re not like other insurance companies. From our specialty products to our business model, our culture to our results — we’re different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn’t just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us.  RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar — a testament to our culture and validation of our reputation as an excellent underwriting company....

At Cotality, we are driven by a single mission—to make the property industry faster, smarter, and more people-centric. Cotality is the trusted source for property intelligence, with unmatched precision, depth, breadth, and insights across the entire ecosystem. Our talented team of 5,000 employees globally uses our network, scale, connectivity and technology to drive the largest asset class in the world. Join us as we work toward our vision of fueling a thriving global property ecosystem and a more resilient society. Cotality is committed to cultivating a diverse and inclusive work culture that inspires innovation and bold thinking; it's a place where you can collaborate, feel valued, develop skills and directly impact the real estate economy. We know our people are our greatest asset. At Cotality, you can be yourself, lift people up and make an impact. By putting clients first and continuously innovating, we're working together to set the pace for unlocking new possibilities...

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary: The Assistant Vice President within Arch Construction Specialty Products is responsible for the day-to-day technical underwriting and account management of construction professional liability (PL) and contractor’s pollution (CPL) book of business.  Responsibilities and Accountabilities: 1. Technical Underwriting Solicits and reviews new and renewal account information required to evaluate a risk. Identifies all potential exposures and hazards in relation to coverage requested and individual risk characteristics. Engage other internal resources as necessary Underwrites prices and prepares proposals based on objective and subject risk...

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: Direct and manage a staff of highly experienced accountants, analysts and managers in the performance of a variety of more complex financial analysis and reporting activities. Provide leadership in the development, design, implementation and on-going management of assigned financial analysis processes. Provide training and guidance to subordinates with respect to understanding, analyzing and...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Software Engineer 2. This individual will need extensive technical expertise to join our dynamic development team. Responsibilities include designing, developing, and maintaining software solutions in a hybrid development environment, encompassing on-premises, cloud, and hybrid infrastructures. The ideal candidate should have strong experience with C#, .NET, and React, along with a deep understanding of modern development practices across various environments. Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status.   ESSENTIAL RESPONSIBILITIES Design, develop, and maintain software solutions using C#, .NET, and React in on-premise, cloud, and hybrid environments. Collaborate with product managers, architects, and other developers to gather and translate business requirements into technical...