- Humana (Austin, TX)
- …medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, ... management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. + Utilization management… more
- Fujifilm (Austin, TX)
- …on the Fujifilm Healthcare Code of Conduct, Interactions with Healthcare Professionals Policy, Anti-Kickback, False Claims Act, HIPAA, Anti-Corruption Policy ... **Minimum of 2 years of experience with Antitrust.** + Strong understanding of healthcare regulations (eg, Anti-Kickback Statute, False Claims Act) and global… more
- Highmark Health (Austin, TX)
- …experience within one or more Epic modules. **Preferred** + 2+ years of Healthcare Revenue Cycle experience ( Claims , Patient Access, Billing) + Epic ... **Preferred** + Bachelor's degree in Computer Science, Information Systems, Healthcare or relevant experience. **LICENSES or CERTIFICATIONS** **Required** + Epic… more
- Catholic Health Initiatives (Bryan, TX)
- …and objectives. Responsible for assisting patients with questions on insurance claims , home healthcare , and medical equipment. Responsible for administering, ... directing, planning, and coordinating all office activities. Provides information to patients so they may fully use and benefit from clinic/office services. **Job Requirements** **_Education_** Required: High school graduate **_Experience_** Minimum 1 year… more
- NTT America, Inc. (Plano, TX)
- …Denials + Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process + Knowledge of healthcare insurance policy concepts including ... these roles you will** **be responsible for:** + Review and process insurance claims . + Validate Member, Provider and other Claim's information. + Determine accurate… more
- Molina Healthcare (Fort Worth, TX)
- JOB DESCRIPTION **Job Summary** Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Health Care Service Corporation (Richardson, TX)
- …(eg, agentic AI) is strongly preferred. * Previous experience working with insurance claims systems and/or healthcare experience * Experience with Iterative / ... drive revenue growth, improve our operational and member-facing processes, and affect how healthcare is delivered to our 17 million members. An ideal candidate is… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Oracle (Austin, TX)
- …and predictive analytics. * Apply generative AI to synthesize insights from multi-modal healthcare data (eg, EHRs, imaging, claims , and demographics) to enhance ... Oracle Health Data Intelligence (HDI) is leading the charge in transforming healthcare with innovative data and AI solutions. We're seeking a highly skilled… more
- Molina Healthcare (Dallas, TX)
- …Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, ... likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… more