- Molina Healthcare (TX)
- …models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional teams, including data ... as Cloudera Manager, Ambari, and Zookeeper. * Enforce data quality , security, and compliance standards using tools such as...working in the healthcare industry with familiarity in clinical, claims , or care management data. * Experience with cloud… more
- Molina Healthcare (Fort Worth, TX)
- …Ability to influence across multiple organizational functions - Payment Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in managing complex ... implement efficient enterprise-wide processes and governance structures that span claims , encounters, clinical, finance and actuarial functions. + Identifies,… more
- Kelsey-Seybold Clinic (TX)
- …members, providers, and various customers while consistently exceeding productivity, quality and service standards. Member Service Representatives II-KSPA have ... to administrative issues related to health plan operations including claims resolution, premium billing, medical benefit interpretation, organization and coverage… more
- Houston Methodist (Katy, TX)
- …or changes in payor requirements, including any barriers or obstacles. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Obtains corrected information and requests rebills as ... **FINANCE ESSENTIAL FUNCTIONS** + Follows up on assigned delinquent insurance claims . Ensures maximization of collection dollars from insurance companies in… more
- Baylor Scott & White Health (Plano, TX)
- …in a physician's office, clinic, or other area. This role ensures high- quality , patient-centered care. This senior position handles complex tasks and escalations. It ... as needed and in conjunction with the Manager or Supervisor. + Performs quality assurance audits. + Orders supplies as requested. **Key Success Factors** + Excellent… more
- Insight Global (San Antonio, TX)
- …assigned MRO for technical matters, delivery schedules, invoice discrepancies, warranty claims , and disposition of airline-owned materials. * Maintains and applies ... able to guide and monitor work-in-progress ensuring all vendor workmanship is acceptable quality and that all work is accomplished in accordance with the work scope… more
- Evolent (Austin, TX)
- …Strategic Accounts, Analytics, Client Finance, Implementation, Clinical Operations, Medical, Quality , and Call Center Teams) to identify new opportunities, deploy ... operational improvement initiatives to improve performance, satisfaction, and clinical quality /outcomes. **Teamwork/Collaboration** - serves as a liaison between the… more
- Zelis (Plano, TX)
- …team to refine into user stories with acceptance criteria, including creating test cases/ claims with expected pricing outcomes . + Perform analysis of various data ... to determine and document business requirements. + Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections. + Educate… more
- BrightSpring Health Services (Corpus Christi, TX)
- …needs of our clients across various lines of business. If your passion is to ensure quality care to help our clients live their best life we encourage you to apply ... personnel costs, consultant services + Monitors worker's compensation and unemployment claims for assigned service site(s). Is proactive in efforts to reduce… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with ... needed. + Collaborates with the medical billing team to improve the quality of clinical documentation for compliance, billing, coding, and reimbursement processes. +… more