- Molina Healthcare (Fort Worth, TX)
- …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education**… more
- UTMB Health (Galveston, TX)
- …Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or ... hospital claims . Identifies billing issues affecting hospital and/or physicians claims /accounts and takes necessary action to ensure timely and appropriate claim… more
- Molina Healthcare (Austin, TX)
- …statuses and risks, and facilitating calls with cross-functional teams + Claims processing , provider contacting, health data analysis and reporting, ... rejection inventory, and works with other areas including IT, health plan, claims , provider, enrollment, regulators, and external vendors, as needed, to remediate… more
- Molina Healthcare (San Antonio, TX)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- Molina Healthcare (San Antonio, TX)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- Baylor Scott & White Health (Austin, TX)
- …appropriate statistical trend analysis. + Performs root cause analysis of claims /encounters processing and submission issues; develops recommendations based on ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… more
- Sedgwick (Austin, TX)
- …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Health Care Service Corporation (Richardson, TX)
- … auditing experience is a strong plus. + Knowledge of or experience with BlueChip claims processing is a strong plus. + Knowledge of quality review processes is ... findings for analysis and rebuttal with internal business partners that support claims and customer service to contribute to ensuring department, divisional and… 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 ... and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication skills +… more
- Molina Healthcare (Dallas, TX)
- …Ensure that provider information is loaded accurately to allow for proper claims processing , outbound reporting and directory processes. **JOB QUALIFICATIONS** ... for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims… more