- Sedgwick (Irving, TX)
- …system documentation.** **Coordinates investigative efforts to ensure thorough and appropriate claim reviews.** **Identifies when claims require external support ... : **At Sedgwick,** **caring counts** **. We're a global leader in claims management, and we're looking for experienced, compassionate professionals to join us… more
- Highmark Health (Austin, TX)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly… more
- Sedgwick (Irving, TX)
- …federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Informs ... and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims ...Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to… more
- Sedgwick (Irving, TX)
- …federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** * Informs ... and/or client requirements for a qualifying condition. * Makes claim determinations to approve non-complex ADA claims ...Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to… more
- Sedgwick (Irving, TX)
- …Security Disability Income (SSDI), and other disability offsets; and to ensure the ongoing processing of claims . **ARE YOU AN IDEAL CANDIDATE?** We are looking ... naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes… more
- Robert Half Accountemps (Dallas, TX)
- …patient and insurance/third party payer accounts with a debit balance to ensure receipt and processing of claim within 45 days from the date of service. Perform ... appeals for underpaid claims or claim denials as assigned by the Billing Manager. Procure payment or establish payment arrangements with patients and/or… more
- Molina Healthcare (Austin, TX)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments...years operational managed care experience (call center, appeals or claims environment). + Health claims processing… more
- Molina Healthcare (San Antonio, TX)
- …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates...**Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims … more
- Prime Therapeutics (Austin, TX)
- …combined pharmacy and PBM experience to include: 1 year of work experience in claims processing in an operations, audit or quality assurance environment, and 1 ... skill and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication… more
- CVS Health (Irving, TX)
- … Database (APCD) experience, Audit Command Language (ACL), or SQL; knowledge of claim processing , claim quality audit program, patient management, and/or ... and within a team. Responsibilities include review of All Payers Claim Database (APCD) state regulations, review of compliance interpretation, writing business… more