• Analyst, Configuration Oversight (Claims Auditor)

    Molina Healthcare (Fort Worth, TX)
    …all claim types of reimbursements not limited to payment methodologies such Stoploss, DRG , APC, RBRVS, FFS applicable for HD Inpatient , Outpatient and ... **Job Description** Responsible for comprehensive contract review and target claim audits review . This includes but not limited to; deep dive contract review … more
    Molina Healthcare (09/17/25)
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  • Compliance Audit Manager

    Cardinal Health (Austin, TX)
    …and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Manages focused ... data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.… more
    Cardinal Health (08/27/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals ... denials for level of care, medical necessity, and as appropriate, DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management… more
    Houston Methodist (07/31/25)
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  • Manager, Appeals & Grievances…

    Molina Healthcare (TX)
    …**E** **N** **C** **E:** + Min. 6 years' experience in healthcare claims review and/or member dispute resolution. + 2 years leadership experience + Experience ... reviewing all types of medical claims (eg HCFA 1500, Outpatient/ Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB… more
    Molina Healthcare (10/11/25)
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  • Director, Appeals & Grievances (Remote)

    Molina Healthcare (Dallas, TX)
    …experience. **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in ... Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/ Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated… more
    Molina Healthcare (09/26/25)
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