• Medical Claim Review Nurse (RN)

    Molina Healthcare (San Antonio, TX)
    coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder , Certified Medical Audit Specialists, Certified Case Manager , ... for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for review of… more
    Molina Healthcare (09/06/25)
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  • Clinical Compliance Medical Director

    Elevance Health (Grand Prairie, TX)
    …Director** is responsible for providing clinical guidance related to the company's coding guidelines, provider coding audits, and participates in developing an ... includes provider medical record documentation. + Provides clinical guidance regarding coding guidelines and develops provider educational material. + Develops a… more
    Elevance Health (09/24/25)
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  • Investigator

    Highmark Health (Austin, TX)
    …(any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + Accredited Healthcare Fraud ... have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have understanding of technical and… more
    Highmark Health (09/10/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Dallas, TX)
    …home health, pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS Guidelines, MCG, ... one or more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified… more
    Molina Healthcare (09/26/25)
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  • Supervisor, Medical Referrals

    CenterWell (San Antonio, TX)
    …in a physician office, health care, or managed care environment + Certified Medical Coder with one of the following active certifications and with a high degree of ... CCA, CCSP, CCS from AHIMA) + Strong experience in ICD-9, ICD-10 and CPT coding + Payor Portal Experience + Prior management or supervisory experience + Highly… more
    CenterWell (09/25/25)
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  • System Manager Revenue Cycle (Medicare Hospital…

    Houston Methodist (Katy, TX)
    …of Revenue Cycle, to include but not limited to: medical coding , insurance billing, collections, patient account resolution, appeals/denials, customer service, cash ... N/A **LICENSES AND CERTIFICATIONS - PREFERRED** + CPC - Certified Professional Coder (AAPC) -- or equivalent if overseeing revenue integrity related functions… more
    Houston Methodist (08/13/25)
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