- Molina Healthcare (Dallas, TX)
- …education of contracted network providers regarding various health plan procedures and claims payment policies. * Develops and implements tracking tools to ensure ... and timely intervention/communication when providers have issues or complaints (eg claims and encounter data, eligibility, reimbursement, and provider website). *… more
- Mass Markets (Killeen, TX)
- …listen to customer needs and provide effective, personalized solutions. + Use internal systems to manage accounts and process claims accurately. + Follow ... effective problem-solving. + Participate in training and stay current on system and process updates. + Meet attendance and scheduling expectations consistently.… more
- Sedgwick (Fort Worth, TX)
- …and cost estimates, and the establishment and implementation of applications, systems and programs. ESSENTIAL RESPONSIBILITIES MAY INCLUDE + Manages software ... estimates, and the establishment and implementation of new or revised applications, systems and programs. + Consults with and directs colleagues in other information… more
- Baylor Scott & White Health (Austin, TX)
- …other data sources, including vendor derived data, electronic health records, and claims data. + Analyze Healthcare Data: Conduct detailed analyses on complex ... HEDIS, Stars measures and Regulatory specifications. Experience in admin claims data sources such as medical/pharmacy claims ,...- 3 Years of Experience As a health care system committed to improving the health of those we… more
- Houston Methodist (Houston, TX)
- …responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist is required to perform ... ESSENTIAL FUNCTIONS** + Collaborates with management to target complex claims and reduce aging of accounts by providing verbal...Documents clear, concise and complete follow up notes in system for each account worked. + Identifies, analyzes and… more
- HCA Healthcare (Houston, TX)
- …ability to grow strategic payer relationships and obtain understanding of payer system to navigate through claims processing centers. Critical thinking skills ... Team for legal action. **In this role you will:** + Analyzes hospital claims to identify contractual underpayments or billing errors. + Resolves underpaid claims… more
- Evolent (Austin, TX)
- …specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would ... a related discipline) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care, or related… more
- Evolent (Austin, TX)
- …specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would ... to executive internal/external audiences. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **The Experience You'll… more
- Cardinal Health (Austin, TX)
- …data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that ... gaps + Ensure HIPAA/privacy safeguards and appropriate minimum necessary use of PHI/ claims . + Define and operationalize Reach (# of targeted HCPs/accounts touched)… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …plans and change controls per Otsuka Policies and Procedures. Dispositions quality system records to ensure their timely initiation, execution, and closure. + ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
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