- Highmark Health (Austin, TX)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent… more
- Humana (Austin, TX)
- …Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience ... hours/day, 5 days/week. **Required Qualifications** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of… more
- ManpowerGroup (Houston, TX)
- …configuration of the system for provider contracts, benefits and fee schedules Claims adjudication experience (preferred) Skilled in using technology to provide/ ... and external auditing and real-time monitoring activities related to the Health Plan's regulatory and contractual requirements in accordance with the Compliance… more
- Guidehouse (San Antonio, TX)
- …builds within Oracle Health (Cerner) EHR for insurance verification, claims submission, payment processing , account follow-up, records maintenance, and ... Cycle Management (RCM) professionals in support of our Military Health System client. These teammates will bring a vast...Federal or DoD "PUBLIC TRUST"; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with… more
- Molina Healthcare (Austin, TX)
- …of pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication , state, NCQA, and CMS policy/guidelines, and any other ... manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state… more