- Molina Healthcare (San Antonio, 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
- Molina Healthcare (San Antonio, 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 (San Antonio, 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
- San Antonio Behavioral Health (San Antonio, TX)
- …hospital admissions and extended hospitals stays. Completing data collection of demographics, claim and medical information; non- medical analysis; and ... The Utilization Review Coordinator conducts utilization reviews to determine if...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities The Geriatric and Extended Care ... Medical Practitioner will provide high quality patient centered care...other GEC providers. - Participates in chart reviews, peer review and other process improvement initiatives. The staff will… more
- Ethos Veterinary Health (San Antonio, TX)
- …What You'll Do: Key Responsibilities: + Patient Care : Maintain accurate medical records, provide owner updates, facilitate visits, and ensure clean and prepared ... Financials : Create and audit estimates/invoices, handle payments, deposits, and insurance claims . + Diagnostics : Collect and track lab samples, manage imaging… more
- Elevance Health (San Antonio, TX)
- …+ Obtains intake (demographic) information from caller. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. ... and documentation. + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more