- Humana (Austin, TX)
- …in Texas and other states. This is accomplished by analysis and adjudication of claims , appeals, and potential quality of care issues. The Dental Director - Texas ... with review policies, procedures, and performance standards. o Review dental claims consistent with current ADA CDT terminology and current professional standards… more
- Sedgwick (Austin, TX)
- …Competencies _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency ... in job postings. Actual compensation is influenced by a wide range of factors...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… 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
- UIC Government Services and the Bowhead Family of Companies (Plano, TX)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more
- Sedgwick (Austin, TX)
- …and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in ... job postings. Actual compensation is influenced by a wide range of factors...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Humana (Austin, TX)
- …an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... researching medical claims + Proficient in Microsoft Office (Word, Excel, Access,...be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
- Molina Healthcare (San Antonio, TX)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Humana (Austin, TX)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Sedgwick (Austin, TX)
- …at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job ... postings. Actual compensation is influenced by a wide range of factors...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Molina Healthcare (TX)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims , Provider Services and Contracting. * Identifies issues, resolves problems… more