- Molina Healthcare (Fort Worth, TX)
- …Qualifications * At least 3 years clinical nursing experience in claims auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization ... Information Technician (RHIT) or Registered Health Information Administrator (RHIA). * Claims auditing, quality assurance, or recovery auditing, ideally in… more
- Molina Healthcare (Fort Worth, TX)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery which improves encounter submissions, reduces General and Administrative expenses… more
- Molina Healthcare (Fort Worth, TX)
- …review to facilitate a referral to law enforcement or for payment recovery . **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical ... records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines,...+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional… more