- IQVIA (Houston, TX)
- …as co-pay cards or vouchers. The **Care Navigator** is primarily responsible for receiving medical claims from HCPs or patients and vetting the claim against ... an IQVIA full-time employee. **Job Responsibilities:** + Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate… more
- Molina Healthcare (San Antonio, TX)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program… more
- Methodist Health System (Dallas, TX)
- …interactions with physicians and office staffs. * Must demonstrate understanding of medical claims billing and coding practices. * Ability to analyze ... physicians and office personnel on the health plan contracts, fee schedules, claims processes, and regulatory requirements. * Serves as liaison between MHS… more
- Sedgwick (Houston, TX)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Humana (Austin, TX)
- …to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing ... and researching medical claims + Proficient in Microsoft Office (Word, Excel, Access, PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats… more
- TEKsystems (West Lake Hills, TX)
- …experts, data scientists, and legal consultants to shape the future of medical claims review and healthcare resource optimization. Job Responsibilities: * ... * Develop economic models to assess the impact of medical interventions and policy changes. * Conduct cost-benefit and...* Collaborate on the design of predictive tools for claims review and risk stratification. * Prepare reports and… more
- Humana (Austin, TX)
- …or FSA designation, MAAA + 2+ years of actuarial experience in health insurance and/or medical claims analytics + Proficiency in data analysis and one or more ... Qualifications** + Strong communication skills + Strong working knowledge of healthcare claims as it relates to trend analytics, total cost of care management,… more
- Sedgwick (Fort Worth, TX)
- …, dental vision, 401K on day one. **Skills & Knowledge** + Knowledge of medical terminology + Understanding of claims management + Excellent oral and written ... Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...PURPOSE** **:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the… more
- Molina Healthcare (TX)
- …as the professional scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate ... tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical documentation, and itemized bills. + Leads… more
- Houston Methodist (Houston, TX)
- …changes are needed. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Analyzes data from various sources ( medical records, claims data, payer medical policies, etc.), ... + Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate … more