- CVS Health (Austin, TX)
- …every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a ... and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.… more
- Republic Finance, LLC (Odessa, TX)
- …performing risk analysis, making credit decisions, administering loan closings, and processing insurance claims . Your management abilities shine as you ... assist the Branch Manager with recruiting and training as well as developing and implementing plans to meet sales goals, promote our core values, and ensure an outstanding client experience. If you love digging in to get the job done and seeing your hard work… more
- ManpowerGroup (Houston, TX)
- …areas remain organized and clean . Maintaining accurate patient records . Processing insurance claims and performing billing tasks . Handling pharmacy-related ... administrative tasks, such as filing, updating patient profiles, and maintaining records . Interacting with patients to obtain and verify their prescriptions . Providing information and answering questions regarding medications and their use . Assisting… more
- Humana (Austin, TX)
- …of experience researching MS-DRG, APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Walmart (Sherman, TX)
- …resolves problems in the prescription fulfillment process when necessary by processing information for third-party insurance claims ; rescanning illegible images; ... procedures by assisting the pharmacist in the prescription fulfillment process; processing third party insurance claims and/or rejections; assisting… more
- Walgreens (Dallas, TX)
- …enhancements to pharmacy systems to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... payment rejections. Follows-up with insurance companies as well as medical providers and participates in 3rd party audit. + Follows-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest… more
- Walgreens (Houston, TX)
- …pharmacy errors and the Continuous Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... payment rejections. Follows-up with insurance companies as well as medical providers and conducts or participates in 3rd party audit. + Assists and supports Store Manager and Pharmacy Manager in analyzing and seeking to improve pharmacy financials, operational… more
- Walgreens (Bridgeport, TX)
- …Seeks new and better ways to further promote productivity. + Ensures the accurate processing of insurance claims to resolve patient issues and prevent payment ... rejections. Follows up with insurance companies and medical providers and conducts or participates in 3rd party audits. + Follow-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest… more
- Walgreens (Plano, TX)
- …enhancements to pharmacy systems to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... payment rejections. Follows- up with insurance companies as well as medical providers and participates in 3rd party audit. + Follows-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest… more
- Molina Healthcare (TX)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more