- Walgreens (Texas City, TX)
- …when using the pharmacy. Enhances customer experience by increasing focus on healthcare services. ** Operations ** + Responsible for assisting pharmacist in the ... federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations , administrative activities; Ensures efficient pharmacy workflow and a… more
- Option Care Health (Houston, TX)
- …culture that attracts, hires and retains the best and brightest talent in healthcare . **Job Description Summary:** The Director, Operations is responsible for ... corporate compliance and other established rules and regulations governing the healthcare industry. The role is directly accountable for driving market development… more
- Molina Healthcare (Dallas, TX)
- …as necessary to debug/analyze problems. + Fields direct questions from Molina Operations Staff regarding business, technical and operations rules. + Develops ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- Molina Healthcare (Austin, TX)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... audits as needed + Participate in process improvement initiatives to improve operations + Understands the compliance and regulatory guidelines for each state +… more
- Molina Healthcare (Austin, TX)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including… more
- Caris Life Sciences (Irving, TX)
- …cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare -driven by innovation, compassion, and purpose. **Join us in our mission to ... Caris Life Sciences is seeking an experienced and strategic Director of Billing Operations - Appeals to lead the appeals management function for an assigned payor… more
- CVS Health (Austin, TX)
- …sponsors' benefit requirements and facilitate the design and implementation of customized healthcare benefit plans. + Provide expert advice and guidance on benefit ... compliance impacting plan sponsors. + Collaborate with internal departments-including claims , customer service, and client management-to ensure effective issue… more
- Methodist Health System (Dallas, TX)
- …billing processes. The ideal candidate will bring a robust background in healthcare revenue cycle management, with a particular emphasis on addressing and resolving ... no response claims , rejected or denied claims , and managing...a fast-paced environment and manage multiple priorities. Proficiency in healthcare billing software, systems and payer portals (eg, Epic,… more
- Evolent (Austin, TX)
- …analyses into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based ... RVUs, bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing… more
- Evolent (Austin, TX)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... Bachelor's degree, preferably with a quantitative major (eg actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health… more