- Zelis (Plano, TX)
- …+ A good understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing, contracting, preferred-provider ... paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical , dental, vision, and prescription drug coverage.… more
- New Jersey Resources (Houston, TX)
- …culture that mitigates and manages risk. Proactively identify environmental, health , safety and wellness, and compliance-related risks, opportunities, trends, and ... (eg FERC, PHMSA, PADEP, MDEQ and MSOGB). Ensure compliance with occupational health and safety laws and regulations, company policies and operating procedures.… 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, ... Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific… more
- R1 RCM (Austin, TX)
- …in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third-Party contracts, minimum of two years ... solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company… 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 ... part of our caring community and help us put health first** Become a part of our caring community...and researching medical claims + Proficient in Microsoft Office… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Dental Director is responsible for providing clinical oversight to promote the oral ... health of the member population that Humana serves in...states. This is accomplished by analysis and adjudication of claims , appeals, and potential quality of care issues. The… more
- Evolent (Austin, TX)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization… more
- Evolent (Austin, TX)
- **Your Future Evolves Here** Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit ... growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great...products. This role plays a critical part in both ** Medical Cost Management** and **Product Management** , leveraging advanced… more
- Molina Healthcare (San Antonio, TX)
- …reporting and monitoring process, including HEDIS, state-based measure reporting and medical record review. + Manages annual HEDIS data collection activities. ... manage contacts within the plan(s) and/or Molina corporate, external auditors, software and medical record vendors, and other Molina departments, such as Claims ,… more
- Houston Methodist (Houston, TX)
- …with Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the ... protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review. - Reviews...and supports more than 1,000 trainees in residence for medical , nursing, allied health and research education… more