- Molina Healthcare (Dallas, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… 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
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… 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
- Molina Healthcare (Dallas, TX)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Dallas, 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
- Fresenius Medical Center (Plano, TX)
- …accuracy. + Overseeing the monthly close process of the Advantx and Medical Manager sub-systems and providing the accounting department with cash deposits, projected ... resolution. + Reviewing and monitoring routine follow-up activities of unpaid claims team for effectiveness; setting performance measurements to improve collections… 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 collaborative member of a multidisciplinary mental health team at the Dallas VA Medical Center as well as the larger combined team of all residential programs at… more
- Insight Global (Dallas, TX)
- …changes Track patient progress and document outcomes in the electronic medical record (EMR) Coordinate care transitions, including hospital follow-ups, palliative ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more