- Molina Healthcare (San Antonio, TX)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 10 years' experience in Managed Care , specifically government programs and/or Medicare/Duals Health Plan ... Operations or equivalent combination of education and experience. + Strong leadership in a matrixed environment + Demonstrated adaptability and flexibility to a rapidly moving business environment. + Background analyzing technical performance and driving teams… more
- Molina Healthcare (Austin, TX)
- …experience and at least 2 years experience in the overread role. + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA. **PR** **E** **FE** ... **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C**… more
- Molina Healthcare (Houston, TX)
- …or equivalent combination of education and experience **Required Experience** + Min. 3 years managed care experience + Experience in one or more of the ... following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar. + Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria. **Preferred Education** Bachelor's Degree… more
- Houston Methodist (Houston, TX)
- …reimbursement policies and procedures + Understands payor environment such as managed care , independent physician associations (IPAs), and third-party ... administrators (TPAs) + Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process + Understanding of revenue cycle fundamentals + Ability to follow-through and handle multiple tasks simultaneously + Excellent… more
- Molina Healthcare (Fort Worth, TX)
- …**Required Experience** + 5-7 years of business analysis experience, + 6+ years managed care experience. + Demonstrates proficiency in a variety of concepts, ... practices, and procedures applicable to job-related subject areas. **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** + 3-5 years of formal training in Project Management + Experience… more
- Houston Methodist (Houston, TX)
- …positive language principles + Understands payor plan policies and environment for government, managed care , IPAs, and TPAs + Exercises good judgment in handling ... of accounts and demonstrates a professional approach in dealing with patients and insurance companies. + Understanding of insurance contractual agreements, payer policies, guidelines and appeals process. + Sharp analytical abilities are required in order to… more
- Prime Healthcare (Harlingen, TX)
- …Account Representative is responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. ... Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement of Hospital's receivables. Proactively works with payers and in-house resources to identify… more
- Molina Healthcare (Fort Worth, TX)
- …**N** **C** **E:** + 3+ years of medical record abstraction experience + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA. **PR** **E** ... **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I**… more
- US Anesthesia Partners (Dallas, TX)
- …in an office environment. + Involves frequent contact with professional staff, managed care organizations, various Department of Insurance, and arbitrators. + ... Work may be stressful at times. + Interaction with others is frequent and often disruptive. disclaimer: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not… more
- Centene Corporation (Austin, TX)
- …leadership role is required + Strong financial and analytical background is required + Managed care or health insurance industry experience is preferred + At ... least 3 years of management experience is required + If not located in St. Louis, monthly travel to Corporate Headquarters for team meetings would be required (2-3 days at a time) **License/Certification:** **N/A:** Pay Range: $145,100.00 - $268,800.00 per… more