- Elevance Health (Houston, TX)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Evolent (Austin, TX)
- …+ Ability to solve novel problems in creative ways is preferred + Previous healthcare experience with a focus in claims and prior authorization data is ... preferred **To comply with HIPAA security standards (45 CFR sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …LTC pharmacies, and integrated delivery networks to co-create value for Otsuka, healthcare providers, and the patients they serve. **Job Description** + Collaborate ... broader commercial environment to identify best practices in the healthcare ecosystem, including LTC, and integrate them into Otsuka...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Sharecare (Austin, TX)
- …2-yr associates degree in healthcare /health sciences OR equivalent experience in healthcare , preferably helping members navigate benefits and claims , OR held ... through personalized resource and referral facilitation, issue resolution and healthcare navigation. Utilizing motivational interviewing and guided approaches, the… more
- Elevance Health (Grand Prairie, TX)
- …identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid ... on fraudulent claims . Health insurance experience required with understanding of health...+ Responsible for independently identifying and developing enterprise-wide specific healthcare investigations and initiatives that may impact more than… more
- Humana (Austin, TX)
- …first** Humana's Clinical Analytics Team is seeking a Research Scientist 2 (Remote). Healthcare is rapidly changing, and our members are living longer, often with ... 2 will lead research, evaluation and development of opportunities that optimize healthcare delivery, lower medical cost while improve member health outcomes, through… more
- Elevance Health (Grand Prairie, TX)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Baylor Scott & White Health (Dallas, TX)
- …individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core ... and civil litigation matters. Reporting to the system Vice President overseeing claims for Baylor Scott & White Health (BSWH). The Director-Assistant General Counsel… more
- Elevance Health (Houston, TX)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches...and medical records prior to payment. + Researches new healthcare related questions as necessary to aid in investigations.… more
- Baylor Scott & White Health (Plano, TX)
- …individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core ... patient harm. If organizational risk is found, the Corporate claims manager will review the event further. The CRM...risk. **Key Success Factors** + Bachelor's Degree in a healthcare field and four years of clinical experience. Or,… more