- KPH Healthcare Services, Inc. (Longview, TX)
- …complex or uncollectible accounts to management for further action. + Submit appeals /claim corrections as needed within timely filing limits. + Utilize billing ... software to maintain accurate and detailed records of all collection activities, including communication with payers and patients. + Payer projects as assigned. + Identify and report trends in claim denials and payment challenges. +… more
- Methodist Health System (Dallas, TX)
- …of surgery date and schedules 1 week post op appointment. * Handle all appeals and denials in conjunction with patient's care. * Participate in patient education ... seminars or meet the doctor events with other members of practice staff, educating interested parties about the surgery program. * Prepare physical space for seminars/events. * Assist other staff members to deliver the highest quality of patient care which… more
- Evolent (Austin, TX)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with… more
- Houston Methodist (Houston, TX)
- …hospital and PO billing, collections, reimbursement, contractual agreements and the appeals process, and hospital charity programs + Excellent communication and ... negotiation skills, as well as an ability to work independently and interdependently with other business office staff + Sharp analytical abilities in order to recognize individual patient circumstances and options for resolution + Proficient computer skills… more
- Sumitomo Pharma (Austin, TX)
- …portfolio, including hub services (benefits investigation, prior authorization, and appeals support), field reimbursement managers, Patient Assistance Program (PAP) ... and copay assistance programs + Drive **data-driven decision-making** , leveraging patient insights and real-world evidence to refine program effectiveness, + **Vendor Oversight** + Oversee **third-party service providers** , ensuring high-quality execution… more
- Robert Half Legal (Houston, TX)
- …and review complex legal documents, including pleadings, motions, briefs, and appeals . * Formulate and execute effective litigation strategies to achieve favorable ... outcomes. * Negotiate settlements and resolve disputes in alignment with client objectives. * Conduct thorough legal research to remain current with relevant laws and regulations. * Communicate regularly with clients, opposing counsel, and court officials to… more
- Texas A&M University System (Kingsville, TX)
- …+ Coordinates room/department assignment processes. + Organizes and coordinates housing appeals . + Facilities managing and enhancing physical aspects of residence ... halls. + Develops, coordinates, and oversees various programs, conferences, trainings, and student/staff development activities, including the first-year experience program and themed housing programs. + Aids in the recruitment, selection, training,… more
- Intermountain Health (Austin, TX)
- …updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7. ... Complies with all CMS, Federal and State regulations, and payor guidelines, and ensures consistent and compliant application with charge/coding capture, charge editing, and audit and reimbursement practices. Researches and collaborates on regulation updates to… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... position is also responsible for monitoring and improving all revenue cycle metrics and measures, including but not limited to the following: accounts receivable days, cash collections, denials, avoidable write-offs, staff productivity and work quality and… more
- Texas Veterans Commission (Midland, TX)
- …state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises and assists veterans ... and other eligible family members in obtaining benefits, rights, entitlements, and other supportive services. . Consults with medical and legal staff in the development of pertinent evidence to support claims. . Request examinations, re-examination, or… more