- USAA (Plano, TX)
- …to include 6 years of experience working as a Registered Nurse ( RN ), Nurse Practitioner (NP), or Medical Doctor (MD) with accountability for highly ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...+ Expert Advice: Ability to review complicated medical records and medical claims ,… more
- Molina Healthcare (Dallas, TX)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Dallas, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Elevance Health (Grand Prairie, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Elevance Health (Grand Prairie, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Elevance Health (Grand Prairie, TX)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related ... background. **Preferred Skills, Capabilities, and Experiences:** + Coding Certificate or Registered Nurse strongly preferred + Law Enforcement dealing with… more
- Baylor Scott & White Health (Plano, TX)
- …risk is indicated, investigation of the event will be delegated to Corporate claims manager for further review . The CRM will participate, as appropriate, ... relayed Risk Management. With this information, the CRM will review findings and will work collaboratively with Patient Safety...position will support two hospitals; Baylor Scott & White Medical Center - Lake Pointe and Baylor Scott &… more