- Molina Healthcare (Fort Worth, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Baylor Scott & White Health (Dallas, TX)
- …of lost wages for payroll and for all approvals of medical bills per claim file. + Pay and process claims within designated authority level. + Performs other ... and/or level **Job Summary** + Under the Safe Choice Claims Manager, the Safe Choice Claims Specialist...Establish reserve requirements. Identify subrogation potential. Maintain diary. + Review and evaluate medical and lost wages.… more
- Elevance Health (Grand Prairie, TX)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Travelers Insurance Company (Richardson, TX)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Robert Half Accountemps (Dallas, TX)
- … medical or coding denials to the QA Department for nurse review and appeal. * Demands claims for secondary insurance filing and copies explanation ... from the date of service. Perform appeals for underpaid claims or claim denials as assigned by...proper confidentiality on all such information. * Knowledge of medical terminology, CPT and ICD-10 coding, office ethics, and… more
- Sedgwick (Irving, TX)
- …professional needs. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate… more
- Molina Healthcare (Fort Worth, TX)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Veterans Affairs, Veterans Health Administration (Dallas, TX)
- …period. Core responsibilities include the following: Providing comprehensive psychiatric medical care (assessment, consultation, treatment) to patients in the RRTP, ... a multidisciplinary mental health team at the Dallas VA Medical Center as well as the larger combined team...provide clinical supervision for health care professionals such as Nurse Practitioners and Physician Assistants. May be assigned as… more