- Molina Healthcare (San Antonio, TX)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (Dallas, TX)
- …trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- CVS Health (Austin, TX)
- …. 3+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party ... . 5+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party … more
- Evolent (Austin, TX)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... public health, biology) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care,… more
- 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
- Conduent (Dallas, TX)
- …Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will ... where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?**...pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- NTT America, Inc. (Houston, TX)
- …this role include:** + Candidates must have Over all 5+ years' experience in US healthcare Claims Payer. + 6 + year(s) experience in Configuring client System ... **Client's business problem to solve?** Our client provides access to high-quality healthcare , innovative programs and a wide range of health solutions that help… more
- Humana (Austin, TX)
- …JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + ... Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Humana (Austin, TX)
- …from either the state agency or payer perspective + Detailed understanding of healthcare claims Travel: While this is a remote position, occasional travel ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- Highmark Health (Austin, TX)
- …You will proactively identify opportunities to construct and leverage comprehensive healthcare knowledge graphs, integrating diverse patient, provider, claims , ... from concept to prototype. + ** Healthcare Data Familiarity:** Understanding of healthcare data domains ( claims , clinical, EMR) and related ontologies or… more