• Medical Claim Review

    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
    Molina Healthcare (01/21/25)
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  • Nurse and CPC - Clinical Fraud Investigator…

    Elevance Health (Grand Prairie, TX)
    ** Nurse and CPC - Clinical Fraud Investigator II -...control. + Review and conducts analysis of claims and medical records prior to payment. Researches ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
    Elevance Health (12/31/24)
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  • General Liability Technical Specialist

    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
    Travelers Insurance Company (01/11/25)
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  • Psychiatrist - Medical Director - PC Mental…

    Veterans Affairs, Veterans Health Administration (Dallas, TX)
    …by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities Core responsibilities include leading and ... for Veterans. In conjunction with the Clinical Directors and Nurse Manager of this Mental Health Team, the incumbent...(1) Those approved by the Accreditation Council for Graduate Medical Education (ACGME), b) OR [(2) Those approved by… more
    Veterans Affairs, Veterans Health Administration (01/16/25)
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  • Investigator, Coding SIU (Remote)

    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 (12/15/24)
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  • Medical Director

    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
    Molina Healthcare (12/26/24)
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  • Director QA/PI/Risk Management

    Dallas Behavioral Healthcare Hospital (Desoto, TX)
    …and communicates patterns and trends or professional and comprehensive general liability claims experience to the administrative and medical staff. + Makes ... injury. Also, responsible for developing, implementing and monitoring of a quality review program. + Directs the collection, measurement and presentation of data… more
    Dallas Behavioral Healthcare Hospital (01/15/25)
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