- Texas Health Resources (Arlington, TX)
- …PMMC, EPSI, Tableau, Power BI, Alteryx, Excel, Access, or other healthcare pricing and claim systems is a plus. Excellent communication and people skills, with ... Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager 's discretion) Department Highlights: + Hybrid Position + Gain a sense of… more
- Cardinal Health (Austin, TX)
- …billing questions and set up payment arrangements if needed. + Analyze claims , process payments and complete adjustments + Analyze explanation of benefits (EOBs) ... reason for patient responsibility. + Document all activities in the billing system according to departmental procedures. + Liaise with third party vendors supporting… more
- CVS Health (Austin, TX)
- …analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory & ... for diverse audiences + Collaborate with SIU investigators, Program Integrity Manager , and Compliance to understand business processes and translate them into… more
- Elevance Health (Houston, TX)
- …research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Elevance Health (Grand Prairie, TX)
- …visits, referral practices, and specialty care procedures and recommends policy changes and claim 's system changes to pursue cost savings + Reviews results ... Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider… more
- Elevance Health (Grand Prairie, TX)
- …visits, referral practices, and specialty care procedures and recommends policy changes and claim 's system changes to pursue cost savings. + Reviews results ... Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider… more
- Elevance Health (Grand Prairie, TX)
- …to create predictive impact decision making tools + Recommends policy changes and claim 's system changes to pursue cost savings. + Reviews results ... Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider… more
- Chevron Corporation (Houston, TX)
- …management of complex cases (ie co-morbidities, stress & psychiatric illness & injury, claims of employees with a history of adverse action) to facilitate prompt, ... Minimum of 5 years of experience in medical case management or disability claim management. + Demonstrated knowledge of the Microsoft Office products (Outlook, Word,… more
- Molina Healthcare (Houston, TX)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as ... to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and… more
- Walgreens (Mesquite, TX)
- …duties as assigned by Pharmacy Manager , Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ... in accordance with Company policies and procedures. Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions. If PTCB… more