15 payment integrity analyst ii jobs found in Fort Worth, TX

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 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 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 Correspondence Team Lead is responsible for monitoring and tracking all processes pertaining to the Correspondence Team. The Team Lead runs   queries   and maintains reports, as well as trains new employees and keeps up with the correspondence training material. This role may assist the supervisor with additional projects/tasks. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES:  Creates   and   maintains reports in worksheets and formulas in Excel Runs   queries to collate data Merges documents from different operating sources, utilizing Microsoft Word Mail Merge Compiles specific supporting documents to send with correspondence Monitors and tracks completion of all processes Responsible for training all new analysts Responsible for keeping training material up to date Tracks analyst errors and creates   coaching   measures Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of HIPAA regulations...

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 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 Strategic problem solving,...

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...

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 Punctual and consistent attendance required Additional duties as...

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 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...

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.  This is a hybrid position and candidates must reside in Arkansas or Texas. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims...

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.  This position is onsite in Dallas, TX. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic...

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 influence over the Analysts. This is an onsite position in Dallas, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: 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 communications Requires regular and consistent attendance Oversee production while developing, tracking, and enforcing Quota Track all protocol changes made by clients and communicating those changes with the team Perform timely and accurate employee evaluations Assist manager in the hiring process, help conduct interviews Other duties as assigned by manager   KNOWLEDGE &...

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a hybrid position located in Dallas, TX. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or...