- 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
- USAA (San Antonio, TX)
- …Medicare-related claims . + Expert Advice: Ability to review complicated medical records and medical claims , and provide expert advice. Conducts ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...review of complex healthcare fraud investigations and providing claims support + Medical Coding Proficiency: At… more
- Molina Healthcare (San Antonio, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… 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
- 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