- Highmark Health (Austin, TX)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and ... concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
- Capgemini (El Paso, TX)
- …software systems to create Prescription cases and determine coverage, determination and appeals process + Good written and verbal communication skills + The ability ... to display soft skills while moving the call forward + Meeting or exceeding government mandated timelines + Complying with turnaround time, productivity, and quality standards + Conveying resolution to beneficiary or provider via direct communication and… more
- HCA Healthcare (El Paso, TX)
- …The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain ... root cause of denials. **What you will do in this role:** + Analyzes documentation to support codes/DRGs and abstracted data (eg, discharge disposition) for inpatient records for multiple facilities using ICD-10- CM and ICD-10-PCS to include: Principal… more
- UTMB Health (Galveston, TX)
- …guidelines. + Responsible for timely and accurate account resolution, including payer appeals for all denials and underpayments. + Collaborates and communicates with ... all levels of leadership throughout the Enterprise on denials trends and opportunities for maximizing reimbursement. + Responsible for the coordination and provision of personnel and capital resources for Hospital Billing team, as part of RCO. + Provides… more
- Entergy (Beaumont, TX)
- …and preparing cases for mediations/arbitrations, judge and jury trials, and appeals . **_Minimum knowledge, skills, and abilities required of the position_** + ... Proficient in a defined practice area or specialty. + Basic industry knowledge, including awareness of the Company's strategic business values and objectives. + Proficient in a defined practice area or specialty. + Has diverse technical skills and knowledge. +… more
- Humana (Austin, TX)
- …population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers ... Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time… more
- CBRE (Dallas, TX)
- …financing, insurance replacement cost calculation, estate valuation, tax appeals , equitable distribution, corporate employee relocation, investment, or sale. ... + Determine valuation method by selecting approach and techniques for valuing property, ie, cost, direct sales comparison, and income capitalization; identifying property characteristics and attributes. + Prepare appraisal report by describing physical and… more
- Prime Therapeutics (Austin, TX)
- …web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with management on regular ... basis to discuss member interaction and program outcomes. + Maintains appropriate par levels of literature. + Familiarizes self with community resources available, benefit information or any other information that is valued with the program. + Maintains an… more
- Ralliant (Austin, TX)
- …ROI. Create compelling product messaging that differentiates our products and appeals to target audiences. Translate product enhancements into effective messaging ... and programs. + **Fortive Business System:** Leverage the Fortive Business System tools to streamline and standardize best practices across Hengstler-Dynapar Sales. **Qualifications:** + Bachelor's degree in a technical or business field required; an MBA is a… more
- Lincoln Financial (Austin, TX)
- …Works directly and independently with sales to address case issues and appeals , with little direction from underwriting management. * Negotiates more complex ... benefits & pricing on non-experienced rated & experienced rated cases with brokers & representatives. * Analyzes financial health, performance, operations, and personnel levels of customers to determine if additional safeguards or conditions should be included… more