- HCA Healthcare (Pearland, TX)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...you will do in this role:** + Reviews all claims for completeness, reasonableness of charges and appropriateness of… more
- CVS Health (Austin, TX)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. The ... including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management and eligibility.… more
- Southland Industries (Amarillo, TX)
- …operations. . Investigate accidents, near-misses, occupational injuries, and property damage claims . Compile data, take photos, etc.; prepare all pertinent forms and ... benefits for you and your family: + 401(k) Plan + Competitive Pay + ** Medical , Dental, Vision Insurance** + Term Life, AD&D Insurance, and Voluntary Life Insurance +… more
- Molina Healthcare (Dallas, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... Economics, Math, or Computer Science **Preferred Experience** Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: + Proactively… more
- CVS Health (Austin, TX)
- …our various enterprise operations teams using a variety of platforms. We service medical , pharmacy, sales, product and call center support models across the CVS ... Qualifications** + Healthcare Insurance and PBM knowledge including Prior Authorizations, Claims , Rebates, Network contracting, Sales, Call Center Ops and Pharmacy… more
- Evolent (Austin, TX)
- …The Risk Adjustment Coding Manager plays a crucial role in ensuring accurate medical coding and compliance with risk adjustment models. **What You will Be Doing:** ... coding team and operations, ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review. + Ensure compliance and quality… more
- CVS Health (Austin, TX)
- …queue of Medicare complaints. These complaints can include various issues ranging from claims that are adjudicated incorrectly to rude customer service. You will be ... with complaints and/or Center for Medicare and Medicaid Services (CMS) + Medical /RX claim processing knowledge + Bachelors Degree **Education:** High School Diploma… more
- CVS Health (Austin, TX)
- …levers, underwriting and financial models. + Understanding of healthcare and pharmacy claims data and common tools used to manipulate data. + Exceptional ... varying levels of client contacts, including executive leadership, Chief Medical Officers, pharmacy department leadership, provider networks, actuaries, financial… more
- Molina Healthcare (Austin, TX)
- …organized and analytical thinking. Experience with Medicare/Medicaid, MS 365 and familiarity with claims is highly preferred. The Case Manager must be able to work ... case managers. + RNs are assigned cases with members who have complex medical conditions and medication regimens + RNs conduct medication reconciliation when needed.… more
- Robert Half Legal (Mckinney, TX)
- …on clients' lives. Key Responsibilities: + Manage a caseload of personal injury claims in the pre-litigation stage. + Conduct detailed intake interviews with clients ... statutes of limitations. + Gather and analyze essential case information, including medical records, accident reports, and other evidence. + Draft complex demand… more