- Centene Corporation (Mcallen, TX)
- …+ Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics + Perform ... care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations. Project management… more
- Evolent (Austin, TX)
- …accounts + Strong knowledge of health plan operations, care/utilization management, claims processing, value-based care, and the levers to optimize financial ... be leveraged to identify opportunities and actions (including EMR, clinical, authorization, claims , SDoH, etc.); understanding of how to translate data and insights… more
- TAD PGS, Inc. (Plano, TX)
- …navigating sensitive or complex leave scenarios. + Analyze FMLA, STD and WC claims to determine eligibility and certification in compliance with State and Federal ... FMLA, ADA, personal leave, and company-specific time-off policies. Analyzing FMLA claims to determine eligibility and certification in compliance with state and… more
- Zelis (Plano, TX)
- …team to refine into user stories with acceptance criteria, including creating test cases/ claims with expected pricing outcomes . + Perform analysis of various data ... understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing, contracting, preferred-provider organizations,… more
- Elevance Health (Grand Prairie, TX)
- …requirements. + Develop and analyze business performance reports (eg, for claims data, provider data, utilization data) and provides notations of performance ... Microsoft Excel experience. + Facets systems knowledge considered a plus. + Claims and/or Encounters experience preferred. + Experience with Medicaid data preferred.… more
- UIC Government Services and the Bowhead Family of Companies (Plano, TX)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more
- Evolent (Austin, TX)
- …You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population ... with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including prior authorization data… more
- Kelly Services (Irving, TX)
- …reports. + Assists the facility in various tasks, ie handling dealer claims , dealer order tracking/support, dealer return program, budget tracking, dealer contacts. ... + Processes inbound and outbound carrier damage claims . **Job Qualifications:** + Excellent computer skills (Microsoft Office, Excel a major plus) coupled with a… more
- Centene Corporation (Austin, TX)
- …in the Continental United States. **Position Purpose:** Direct and oversee claims audit operations and medical code editing scenarios. Oversee payment integrity ... years of Managed Care or CMS related experience, including compliance, claims , payment integrity, or special investigation experience required. + Previous management… more
- UIC Government Services and the Bowhead Family of Companies (Plano, TX)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more