- Molina Healthcare (San Antonio, TX)
- … System Migrations **Preferred Experience** 6 - 8 years working in a claims processing system . Health care environment experience. To all current Molina ... leadership and direction to MMS Operational Units management staff (eg, Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider… more
- Molina Healthcare (TX)
- …execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as ... Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate payment levels, optimize resource utilization,… more
- Molina Healthcare (Dallas, TX)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis… more
- Travelers Insurance Company (Houston, TX)
- …evaluating, reserving, negotiating and resolving assigned serious and complex General Liability claims . Provides quality claim handling throughout the claim ... is designed to support flexibility. **What Will You Do?** CLAIM HANDLING: + Directly handle assigned severe claims...facts or allegations of each case. + Consult with Manager on use of Claim Coverage Counsel… more
- Quality Technology Services, LLC (Irving, TX)
- …driven. Together, we do great things. **Who You Are:** As a QTS' **Senior** ** Manager , Business Systems Support (Oracle)** you are responsible for executing on ... You Need to be Successful:** + Bachelor's degree in Information Systems , Computer Science, Business Administration or equivalent professional experience **Ten or… more
- Molina Healthcare (Fort Worth, TX)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more
- Molina Healthcare (TX)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience ... Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination… more
- Methodist Health System (Dallas, TX)
- …cycle management, with a particular emphasis on addressing and resolving no response claims , rejected or denied claims , and managing correspondence. This role ... medical billing, or medical reimbursement Proven experience in managing no response claims , denied claims , and billing correspondence. Knowledgeable with payors;… more
- Texas Health Resources (Arlington, TX)
- …+ Core work hours: Monday-Friday 8:00a-5:00p **Summary** The Billing, Coding & Denials Manager will oversee all aspects of claim review and coding denials ... ** Manager Billing Coding and Denials** _Are you looking...and feedback related to coding denials. **Job Duties** Manage Claims /Denials department and staff: Analyze, create and refine department… more
- CDM Smith (Fort Worth, TX)
- …Assist the project team in developing and maintaining a project risk register. Claim management: Early support for claims and disputes on the project. ... to those requirements. Ensure that proper documentation is developed and maintained for claims . **Job Title:** Commercial Manager - Pacific **Group:** CCI ESS… more