- Molina Healthcare (Dallas, TX)
- …and independent contracting, down line broker applications commissions, Broker Agent appeals /grievances, educating Brokers on plan benefits in all markets, managing ... the detailed process of broker commission reconciliation * Handles Broker Agent appeals /grievances. * Educates Brokers on plan benefits in all markets. * Makes… more
- Molina Healthcare (Austin, TX)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Adecco US, Inc. (Irving, TX)
- …barriers. + Manage benefit investigations, prior authorizations, claims escalations, and appeals . + Deliver payer insights and education on Medicare and commercial ... pharmacy. + Experience with prior authorizations, claims processing, and appeals . + Strong communication, presentation, and organizational skills with customer… more
- Adecco US, Inc. (Irving, TX)
- …specific drug (including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals ) and educating the office on Payer landscape and services ... cases by overseeing benefit investigations, prior authorizations, claims escalations, and appeals , ensuring timely patient access. 3. Design and deliver advanced… more
- Molina Healthcare (Austin, TX)
- …+ Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains Point of Sale claims adjudication, state, NCQA, and CMS ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- J&J Family of Companies (Dallas, TX)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) + Ability to establish relationships, collaborate, and influence… more
- J&J Family of Companies (Dallas, TX)
- …assigned. . Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) . Ability to establish relationships, collaborate, and influence… more
- CVS Health (Austin, TX)
- …new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates providers on our self-service ... to incoming correspondence and internal referrals. -Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. -Performs… more
- Highmark Health (Austin, TX)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Cardinal Health (Austin, TX)
- …+ Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Cell/Gene therapy and/or Oncology experience, preferred +… more