- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... for the denials and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case managers by documenting… more
- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This ... complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when necessary. + Resolves denials as they appear with… more
- Houston Methodist (Houston, TX)
- …and monitoring the coding-specific clinical charges and denial management and appeals process in a collaborative environment with revenue cycle management and ... clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a...and determines the need for or feasibility of submitting appeals . + Works with revenue cycle management and staff… more
- Ascension Health (Austin, TX)
- …Responsible for reviewing, investigating and resolving health-care claim payment appeals and communicating resolution/determination in accordance with the standards ... guidelines. + Responsible for the comprehensive research and resolution of claim appeals from health-care providers and related outside agencies to ensure that… more
- Executive Office for US Attorneys and the Office of the US… (Austin, TX)
- …The AUSA will represent the United States in cases before the US Court of Appeals for the Fifth Circuit and will handle all aspects of affirmative and defensive ... appeals from criminal cases arising in the District. Responsibilities...the Criminal Division of the Department of Justice regarding appeals , petitions for rehearing en banc, and litigation in… more
- Humana (Austin, TX)
- …and other states. This is accomplished by analysis and adjudication of claims, appeals , and potential quality of care issues. The Dental Director - Texas assists ... o Review and resolve provider and member grievances and appeals o Provide and advance the clinical vision for...or condition type. May also engage in grievance and appeals reviews and/or condition committees. Travel: While this is… more
- Urology Clinics of North Texas (Mesquite, TX)
- …for a customer-focused office professional to perform collections, filing claims, handle appeals , and correspondence with payers. This position will focus on claims ... to insurance carriers + Review insurance EOB and initiate appeals and as necessary + Respond to Payer's request...ICD10 and use of appropriate modifiers + Experience working appeals and composing appeal letters for oncology cases +… more
- Houston Methodist (Houston, TX)
- …billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity ... or coding related appeals . **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Stays current on collection...knowledge of billing, collections, reimbursement, contractual agreements and the appeals process + Understanding of revenue cycle fundamentals +… more
- Molina Healthcare (Fort Worth, TX)
- …delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances, enrollment, claims, pharmacy, and quality functions. You surface ... 2. Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances, enrollment, claims-so each team addresses systemic defects. 3.… more
- Actalent (Texas City, TX)
- …+ Review submitted documentation and gather additional information to support the appeals process. + Forward completed cases to pharmacists for final determination. ... Skills + Certified Pharmacy Technician (CPhT). + Experience in pharmacy operations, appeals , managed care, claims processing, and handling denials. + Strong data… more