- Texas A&M University System (Killeen, TX)
- …professionally and diplomatically. Informs students and families on the appropriate appeals procedures. Helps appropriate parties understand the outcome of appeal ... decisions. + Utilizes CRM and SIS to maintain student records and databases, audits information for accuracy. + Runs reports and provides statistical analysis for leadership reporting. + Trains and mentors lower-level advisors and associates. + Responds to… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …provider portals for verification of eligibility, benefits, claims status and appeals . **Campus:** HSC - El Paso **Department:** MPIP Account Quality **Required ... Attachments:** Resume / CV, Transcript **Job Type:** Full Time **Pay Statement:** Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as, the institutional pay plan. For… more
- University of Texas Rio Grande Valley (Edinburg, TX)
- …students in the completion of financial aid applications and in processing appeals . + Advises students regarding their financial aid options and responsibilities ... within the programs available in the Financial Aid Office and other related offices. + Maintains knowledge of regulations, eligibility, and documentation requirements concerning financial aid. + Responds to customer inquiries regarding Financial Aid forms,… more
- Evolent (Austin, TX)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a… more
- Highmark Health (Austin, TX)
- …internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides technical assistance in ... researching and resolving inquiries. **ESSENTIAL RESPONSIBILITIES** + Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. + Resolves claim edits, reviews history records and… more
- J&J Family of Companies (Houston, TX)
- …benefit/buy & bill benefit design, coding, billing, prior authorization, and appeals processes + Demonstrated capabilities and performance success in prior roles ... + A valid Driver's License in one of the 50 United States + Reside within the geography or be willing to relocate to it **Preferred Qualifications** + MBA or other advanced degree/relevant certifications preferred + Proven ability to navigate high profile,… more
- Evolent (Austin, TX)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a… more
- Deloitte (Houston, TX)
- …preparation of responses and drafting issue responses as well as more formal appeals . + Preparing business and individual federal and state income and other tax ... returns and forms. + Preparing income tax provisions in accordance with ASC 740 as well as supporting the Deloitte audit team on tax provision reviews, including analyzing the authority level of uncertain tax positions. The successful tax consultant will be… more
- Methodist Health System (Dallas, TX)
- …necessary actions based on correspondence received, such as claim corrections, appeals , or adjustments. - Conduct thorough follow-up on aging accounts receivable, ... prioritizing those with no response or denied claims. Utilize various communication channels to contact payers, patients, and other relevant parties to resolve outstanding balances and secure payment. - Stay up-to-date with changes in healthcare regulations,… more
- Adecco US, Inc. (Austin, TX)
- …case outcome, follow-up or consultation such as prior authorization requirements, appeals , etc. . Educate members / guardians, providers, pharmacy staff on ... procedures to avoid compliance risk. . Meet departmental established performance expectations and working independently to complete tasks in a timely manner. . May include processing member prior authorizations through various computer systems ensuring the… more