- Molina Healthcare (Houston, TX)
- …skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. ... Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Utilizes Power BI to display relevant reporting within a refresh cycle.… more
- CVS Health (Austin, TX)
- …-3-5 years of data interpretation and analysis experience. -Experience with internal claims data and healthcare coding. -Must be able to travel to provide ... testimony if needed. -Advanced experience with Excel. **Preferred Qualifications** Certified Professional Coder Knowledge of CVS/Aetna's policies and procedures **Education** Bachelor's degree or equivalent work experience **Anticipated Weekly Hours** 40… more
- EFI Global (Austin, TX)
- …**Collaborates with sales and operations managers, architects, developers, insurance adjusters, claims managers and attorneys to develop demand for your professional ... services.** **Collaborates with EFI's national team of forensic experts to leverage experiences and assist on projects.** **Education and Licensing:** **Requires Bachelor of Science degree in Engineering from an accredited college or** **university.**… more
- Texas Veterans Commission (Odessa, TX)
- …is strongly preferred. . Experience in processing, developing, or adjudicating VA claims for benefits preferred. . Experience with Microsoft Office Suite strongly ... preferred. *Knowledge, Skills and Abilities:* . Knowledge of VA rules and regulations. . Knowledge of medical terminology. . Skill in interviewing and providing exemplary customer service. . Skill in critical thinking. . Skill in the use of personal computers.… more
- Champion Home Builders Inc. (Burleson, TX)
- …on inventory needs after an inventory is taken. + Reviews purchase order claims and contracts for conformance to company policy. + Prepares and reviews contracts, ... bids, proposals, and vendor agreements for legal correctness, price, and acceptability of items to specifications. + Oversees all activities related to procurement of a commodity, from intent to purchase through delivery of commodity. + Interface with… more
- Prime Therapeutics (Austin, TX)
- …stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business partners ... across the enterprise. **Responsibilities** + Executes compliance procedures and enforces policy governance across the organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory… more
- Evolent (Austin, TX)
- …coding team and operations, ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review. + Ensure compliance and quality ... for all coding practices maintaining high standards and adherence with federal regulations to ensure cohesive and compliant coding per the AHA ICD-10 coding guidelines, AAPC and AHIMA and internal policies. + Conduct regular audits and quality checks for… more
- WTW (Dallas, TX)
- …to day to day service issues and questions (eligibility, carrier coverage and claims issues, compliance, etc.) + Preparation for client meetings (prepare agendas and ... materials, coordinate resources, etc.) + Supporting vendor procurement, implementation, and optimization activities + Providing benefit enrollment support, including preparing materials and presentations, verifying policy and plan information, and updating… more
- Citigroup (San Antonio, TX)
- …unsolicited securities trades (Series 7 & 63 required) as required + Ensures customer claims and complaints are handled in accordance with FINRA and firm policy + ... Ensures that KYC/AML and other compliance norms are strictly adhered to + Builds a rapport with clients; utilizes Salesforce regularly for communication of issues/tasks/opportunities + Builds a rapport with back-office staff and seek out highest level of… more
- Walgreens (Longview, TX)
- …ways to further promote productivity. + Ensures the accurate processing of insurance claims to resolve patient issues and prevent payment rejections. Follows up with ... insurance companies and medical providers and conducts or participates in 3rd party audits. + Follow-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest alternative medications, and… more