- Houston Methodist (Houston, TX)
- …and associated audits by the fiscal inter-mediatry. Also directs re-opening requests and appeals . + Directs the coordination, review and filing of state 1115 waiver ... requirements. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies and implements innovative solutions for practice or workflow changes to improve department, entity or system operations by leading unit projects and/or other department/system-directed… more
- CVS Health (Austin, TX)
- …written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . + Ensure all compliance requirements are satisfied and that ... all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to less experienced staff members. + Utilize all resource… more
- Tarleton State University (Stephenville, TX)
- …rigor of classes and programs; mediate departmental processes for student academic appeals . + Recruitment: Work with the Division of Enrollment Management and the ... College of Graduate Studies to market programs to increase enrollment. + Career Development: Connect students with opportunities for internships, experiential learning, and career exploration. 20% Teaching: + Plan, prepare, and deliver lectures, seminars,… more
- TEKsystems (Houston, TX)
- …and pharmacies + Verify insurance benefits and navigate prior authorizations and appeals + Maintain accurate documentation and follow program SOPs + Collaborate with ... internal teams and external stakeholders to ensure seamless patient journeys + Deliver exceptional customer service while acting as a program representative Qualifications Required Skills: + 2+ years in healthcare reimbursement, insurance verification, or… more
- CVS Health (Austin, TX)
- …and responsibilities in accordance with contract. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. + Performs ... review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. **Required Qualifications** + 1+ years of experience with customer service in a call center or retail environment, demonstrating ability to be… more
- CVS Health (Austin, TX)
- …Health_ ) community resources, renewal of member benefits, claims, complaints & appeals , and assistance with provider related requests. + Conduct member outreach in ... all service areas to include member phone calls and member requests for assistance and member events. + Conduct proper documentation of outreach activities in Salesforce. + Build outreach calendar 90-days out to meet monthly production metrics. + Ensure… 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 ... options; Assists providers with credentialing and re-credentialing issues. -Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits. -Handles extensive file review requests. **Responsibilities** + Answering questions and… more
- Elevance Health (TX)
- …a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any ... embassy located in or outside of the US. + A minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * _For Health Solutions and Carelon organizations (including behavioral… more
- Insight Global (Houston, TX)
- …errors in billing or coding, compiling supporting documentation and submitting appeals to insurance companies to recover outstanding patient balances, while actively ... monitoring claim status and following up with payers to resolve outstanding issues. This person will be working in a catch all que that has a back log of more complex issues. The ideal candidate for this position will have extensive revenue cycle experience… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Responsibility for the preparation of summaries and files for denials, appeals , medical advice, subrogation, and litigation. + Collection of documents and ... summarizing information. + Providing presentations for committee meetings and any required correspondence. + Apply technical knowledge and human relations skills to ensure fair and prompt case disposal. Contribute to a reduced loss ratio. + Assign surveillance… more