- Molina Healthcare (Austin, TX)
- …credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. Ongoing ... Monitoring/Watch Follow-up * Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. * Reviews and processes assigned daily alerts for federal/state and license sanctions and exclusions… more
- Walmart (Austin, TX)
- …up orders are filled Oversees assigned area of responsibility by handling claims and returns zoning the area arranging and organizing merchandise identifying shrink ... and damages organizing and maintaining availability of cartsflatbeds assisting members with transporting items utilizing cart retrieval equipment according to company policies and procedures and maintaining parking lot cleanliness Completes accounting records… more
- Molina Healthcare (Austin, TX)
- …& ABILITIES** : * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed ... healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation and various forms of risk, ASO, etc. **PREFERRED EDUCATION** : Bachelor's Degree in a related… more
- Molina Healthcare (TX)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of SQL ... 2005/2008 SSRS and Power BI report development + Familiar with relational database concepts, and SDLC concepts **Preferred Education** + Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. + Preferred… more
- Centene Corporation (Austin, TX)
- …calls with members and provider offices to provide resolution to claims (ie: additional information requests and medication determination updates) + Thoroughly ... researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards + Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries + Participates in the… more
- Baylor Scott & White Health (Temple, TX)
- …SQL and Python scripting . Knowledge of HealthEdge/HealthRules Payor, or other claims processing systems . Knowledge of Selenium/Cypress tools with Java /Java ... scripting . Knowledge of EDI file formats . Skill in performing thorough regression testing when bugs are resolved . Skill in monitoring debugging process results, troubleshooting and problem-solving . Skill in tracking quality assurance metrics, including… more
- Actalent (Texas City, TX)
- …Pharmacy Technician (CPhT). + Experience in pharmacy operations, appeals, managed care, claims processing, and handling denials. + Strong data entry and customer ... service capabilities. + Proficient in computer systems and applications. + Ability to work independently in a remote environment. Additional Skills & Qualifications + National Pharmacy Technician Certification (CPhT) preferred; required for certain supervisory… more
- Baylor Scott & White Health (Temple, TX)
- …following initial Advocate training. + Serves as a primary contact for benefits, claims status and simple drug inquiries for Personal Plans with working knowledge of ... other products, based on first contact resolution guidelines. Verifies demographic information on all inquiries and updates the Plan system. + Helps Members with concerns and effectively works toward a resolution before the concern escalates to a complaint. +… more
- Walmart (Mckinney, TX)
- …up orders are filled. Oversees assigned area of responsibility by handling claims and returns; zoning the area; arranging and organizing merchandise; identifying ... shrink and damages; organizing and maintaining availability of carts/flatbeds; assisting members with transporting items; utilizing cart retrieval equipment according to company policies and procedures; and maintaining parking lot cleanliness. Completes… more
- Walmart (Dallas, TX)
- …area in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and ... identifying shrink and damages. Receives and stocks merchandise in the Optical area, and organizes and maintains the Optical area by following Company procedures, utilizing equipment appropriately, merchandising, and completing paperwork, logs, and other… more