• Coding Education & Compliance Specialist

    Health Care Service Corporation (Mcallen, TX)
    …efficient. **JOB REQUIREMENTS:** + High School Diploma or GED. + CPC Coding Certification /CPC, CCS, CCSP + 2 years medical coding experience + Experience with ... + Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business + Prior experiences teaching/training others… more
    Health Care Service Corporation (09/27/25)
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  • Referral Coordinator

    ChenMed (Houston, TX)
    …for multiple payers strongly preferred + Healthcare experience within the Medicare Advantage population preferred. + Medical Assistant certification preferred ... approved (when needed). + Schedules patient (Preferred Providers List of Specialist ) and notifies them of appointment information, including, date, time, location,… more
    ChenMed (11/12/25)
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  • Investigator, Coding Special Investigative Unit…

    Molina Healthcare (Dallas, TX)
    …oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School ... documents) and Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification , Association** Licensed registered nurse (RN), Licensed practical nurse… more
    Molina Healthcare (11/20/25)
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  • Senior Clinical Pharmacist - Pipeline

    Humana (Austin, TX)
    …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...to pharmacy + Six Sigma and/or Project Management Professional certification + Pharmacy practice residency or similar pharmacy practice… more
    Humana (11/20/25)
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  • Clinical Manager RN

    HCA Healthcare (San Antonio, TX)
    …preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with medical necessity,… more
    HCA Healthcare (09/19/25)
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  • Profee Coder Surgical Urology

    Banner Health (TX)
    …highly trained staff. Banner Health recently earned Great Place To Work(R) Certification (TM) . This recognition reflects our investment in workplace excellence and ... as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire.** **Please note, this is a COMPLEX role,… more
    Banner Health (11/26/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Austin, TX)
    …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... state licensure required per business needs + Active Board Certification in Interventional Cardiology **or** may be substituted for...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (10/29/25)
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  • Assistant Sr., Patient Therapy Access

    Abbott (Plano, TX)
    …location in **Plano, TX** currently has an opportunity for a **Patient Therapy Access** ** Specialist ** (PTA). This is an in office 5 days a week position. Preferred ... hours 8am to 5pm. As a PTA Specialist you are responsible for facilitating and assisting Abbott patients with the pre- certification , pre-determination and… more
    Abbott (11/22/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Austin, TX)
    …Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically ... appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret… more
    Molina Healthcare (11/14/25)
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  • Physician - Family Medicine

    Kelsey-Seybold Clinic (Humble, TX)
    …a family doctor is not necessary to schedule an appointment with a Kelsey-Seybold specialist , but the family doctor is an important part of the multispecialty team. ... + Medical Degree (MD, DO) + Accredited Family Medicine Residency training **License and Certification :** + Licensed or willing to be licensed in the State of Texas.… more
    Kelsey-Seybold Clinic (11/07/25)
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