• Director, Clinical Data Acquisition

    Molina Healthcare (Fort Worth, TX)
    …measures that support business objectives. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** * Certified Professional in Health Quality (CPHQ) * Nursing License ... state specific audit projects and deliverables related to accurate billing and coding. This role also works with the...(RN may be preferred for specific roles) * Certified Risk Adjustment Coder (CRC) To all… more
    Molina Healthcare (10/22/25)
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  • Payment Integrity Clinician

    Highmark Health (Austin, TX)
    …Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + Demonstrated ability ... SUMMARY** This job requires the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code… more
    Highmark Health (11/14/25)
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  • Clinical Fraud Investigator II - Registered Nurse…

    Elevance Health (Grand Prairie, TX)
    …Requirements:** + Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 ... as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for...our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors… more
    Elevance Health (12/18/25)
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