- Humana (Austin, TX)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Houston Methodist (Houston, TX)
- …procedures, clinical trial protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review . - Reviews Medicare ... Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the following:… more
- Kemper (Mcallen, TX)
- …balance can be highly motivating and productive. **Position Summary:** As Desk Review Specialist, you will be reviewing incoming auto damage demands from other ... parts were utilized within Industry Standards. + Examine third-party Total Loss claims through photos, estimates, total loss valuations to ensure valuations are… more
- Molina Healthcare (Fort Worth, TX)
- …of other insurance records and has a direct impact on medical expenses and premium reimbursement. **KNOWLEDGE/SKILLS/ABILITIES** + Provides telephone, clerical, and ... and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Contacts CMS directly or coordinates… more
- CVS Health (Austin, TX)
- …The ideal candidate will be able to work independently and with others to review claims tied to different overpayment projects in the Overpayment Tracking ... day. **Position Summary** This position will be responsible for utilizing previous ACAS claims experience along with provided guidance to review and validate … more
- Canon USA & Affiliates (Austin, TX)
- …of the business unit. + Support regulatory activities by managing image quality review with external medical experts, providing clinical expertise, and reviewing ... **Mgr Medical Affairs - Clinical Development Sr - HIT...and external experts. Support marketing in developing collaterals and review of collaterals for clinical accuracy and adherence to… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- … Records Clerk/Coder to assign procedure, and diagnosis codes for insurance billing, review claims data, research, and correspond with insurance companies to ... include but are not limited to: + Utilize specialized medical classification software to assign procedure and diagnosis codes...assign procedure and diagnosis codes for insurance billing. + Review claims data to ensure that assigned… more
- Sedgwick (Irving, TX)
- … system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate ... disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining… more
- Sedgwick (Irving, TX)
- … system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate ... disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining… more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims ... **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates… more