- Evolent (Austin, TX)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- Texas Health Resources (Arlington, TX)
- …methodologies and their impact across different provider types, Experience with healthcare claims (Facility and Professional), knowledge of physician ... methodologies and their impact across different provider types, Experience with healthcare claims (Facility and Professional), knowledge of physician… more
- Molina Healthcare (San Antonio, TX)
- **Job Description** **Job Summary** The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims , coordinating, ... investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge… more
- Molina Healthcare (Austin, TX)
- **Job Description** **Job Summary** The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. ... Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims … more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION **Job Summary** Provides support for provider claims adjudication activities including responding to providers to address claim issues, and ... researching, investigating and ensuring appropriate resolution of claims . **Essential Job Duties** * Provides support for resolution of provider claims issues,… more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Molina Healthcare (San Antonio, TX)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Evolent (Austin, TX)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Molina Healthcare (Dallas, TX)
- …for accurate and timely implementation and oversight of critical information on claims databases. Synchronizes data among operational and claims systems and ... experience and knowledge to research and resolve claim/encounter issues, pended claims and facilitate system update(s) as necessary. + Works with fluctuating… more
- Norstella (Austin, TX)
- …(PharmD) or Medicine (MD/DO) degree. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory data, in an ... **The Role:** In this role, you will leverage your expertise in ** healthcare data analytics** to extract meaningful insights from **real-world data (RWD)** sources,… more