- Centene Corporation (Austin, TX)
- …optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and ... medical necessity appeals . + Participates in provider network development and new market expansion as appropriate. + Assists in the development and implementation of… more
- Texas Tech University (Lubbock, TX)
- …funds. + Will work with Operations team members to review SAP appeals , R2TV calculations, and changed circumstances (Professional Judgement) reviews. Inform students ... of approval or denial of financial aid appeals ; inform students when placed on probation or suspension, or if they have been terminated from a financial aid program.… more
- Adecco US, Inc. (Dallas, TX)
- …providers, guiding them through benefit investigations, prior authorizations, claims, and appeals . This client-facing role blends remote work with in-person visits, ... **Reimbursement Support:** Help offices navigate insurance processes-BI, PA, claims, and appeals . + **Relationship Building:** Serve as a trusted advisor to… more
- Insight Global (Irving, TX)
- …role focuses on patient outreach, medication refills, insurance coordination, and appeals , ensuring seamless communication and support across the care continuum. The ... with insurance companies to obtain claims and run tests Draft and submit appeals for denied claims Perform patient outreach via phone and in-person interactions… more
- Molina Healthcare (Fort Worth, TX)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... analyses of advocacy issues; and assists with documentation preparation for appeals , fair hearings or other formal/informal dispute resolution process. * Provides… more
- Humana (Austin, TX)
- …include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The ... population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers… more
- Houston Methodist (Houston, TX)
- …and further delay in payments. Makes recommendations for resolution. Pursues appeals when available. Initiates communication with coding team and clinical staff ... when coding related, and medical necessity appeals are warranted. **FINANCE ESSENTIAL FUNCTIONS** + Manage multiple work queues for missing registration information,… more
- Executive Office for US Attorneys and the Office of the US… (Houston, TX)
- …represents the US Attorney's Office in criminal matters in the United States Court of Appeals for the Fifth Circuit. As an AUSA in the Appellate Division, you will ... matters, and sentencing issues. You will be assigned to work on appeals and post-conviction matters arising from offenses targeted by the Department's Border… more
- HCA Healthcare (Live Oak, TX)
- …and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case management, and utilization review/management ... staff in the reduction of payer denials and in the denial and appeals process, as requested by the Case Management Department and Patient Accounting Services… more
- Select Medical (Dallas, TX)
- …+ Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and account retention. ... position preferred. + Experience with insurance approvals, prior authorizations, and the appeals process. + Experience in workers' compensation is a plus! +… more