- CVS Health (Austin, TX)
- …Conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... plans and practices. - Conducts investigations of known or suspected acts of healthcare fraud and abuse. - Communicates with federal, state, and local law… more
- Catholic Health Initiatives (Sugar Land, TX)
- …reporting process, root cause analyses, investigations and requests from the claims team (including management of subpoenas, Summons and Complaints, and coordination ... **Job Requirements** Required Education and Experience: Bachelor's degree in healthcare or five (5) years of related job or...(or within 24 months of hire): Certified Professional in Healthcare Quality (CPHQ) Healthcare Quality Mgmt (HCQM)… more
- Highmark Health (Austin, TX)
- …strategic thinker with a deep understanding of Highmark, enGen, and the broader healthcare market, as well as exceptional leadership skills and a proven track record ... + Bachelor's degree in a related field (eg, Business Administration, Healthcare Management, Information Technology) **Substitutions** + None **Preferred** + Master's… more
- Humana (Austin, TX)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance… more
- Elevance Health (Grand Prairie, TX)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... payor or provider environment; considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would… more
- Terumo Medical Corporation (Dallas, TX)
- …used in a broad range of applications for numerous areas of the healthcare industry. TMC places a premium on providing customers with world-class products, training ... think outside the box, experiment, innovate and deliver what's next for quality healthcare . You will be part of a collaborative, respectful and resilient team of… more
- Humana (Austin, TX)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, state and… more
- InGenesis (El Paso, TX)
- …errors found. * Assists to reconcile and resolve denied outside provider claims . * Performs record keeping functions. Minimum Qualifications: * High School Diploma ... or GED equivalent. * Minimum of one-year experience in a healthcare setting as a medical record technician, medical record clerk, or similar position. * Minimum of… more
- CVS Health (Austin, TX)
- …a fast-paced, agile environment leveraging cutting-edge technology to reimagine how Healthcare is provided. You will be instrumental in designing, integrating, and ... The position is open in a data engineering team that is responsible for processing Claims , Revenue, Rx Medicare Specific files and data from 30+ payors into our Data… more
- Humana (Austin, TX)
- …+ Experience with identifying and/or reporting fraud, waste and abuse within the healthcare industry + Knowledge of the Medicare and Medicaid programs + Experience ... 2 years of Humana Experience + Knowledge of Humana Medical and Pharmacy Claims Processing Systems + Experience with data query/data programming applications (ie SQL,… more