- Molina Healthcare (San Antonio, TX)
- …Claim Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from… more
- Molina Healthcare (TX)
- …proactively identifying, validating, and tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Prime Therapeutics (Austin, TX)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** ... + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and programs… more
- Elevance Health (Grand Prairie, TX)
- … documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (San Antonio, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Grand Prairie, TX)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... ** Clinical Fraud Investigator II - Registered Nurse and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Houston Methodist (Houston, TX)
- … Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the ... At Houston Methodist, the Manager of Research Billing Compliance position is responsible...protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review . - Reviews… more
- Walgreens (Lubbock, TX)
- …of medications and drug interaction awareness. Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient outcome ... (eg patient consultation, medication management, drug therapy reviews, and perform clinical , or wellness services such as immunizations, diagnostic testing, and… more
- Walgreens (Longview, TX)
- …clinical services. **Job ID:** 1658072BR **Title:** Walgreens Pharmacy Manager **Company Indicator:** Walgreens **Employment Type:** Full-time **Job Function:** ... of medications, awareness with drug interactions. Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Practice Manager position is responsible for independently managing and/or coordinating complex delivery of care within a large, ... position supervises the functions related to front desk, business transactions, clinical support services, compliance, safety and customer service and is responsible… more