- Houston Methodist (Houston, TX)
- …benefits + Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies, coordination of ... peer discussions as directed by the clinical team. Documents authorization, approvals, and denials **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Maintains awareness of payor/reimbursement practices and regulations that may impact patient's plan of care and… more
- Elevance Health (Houston, TX)
- …+ Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners. + ... Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns. + Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a… 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
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …office or via Touchnet to Cognos reports + Review and address parking appeals submitted through the department's functional email or parking system + Maintain ... records for overdue citations, payment arrangements and vehicle impoundments + Provide secondary support to the parking coordinator, assisting with parking registrations and payment collection + Assist with cash handling duties to include daily submissions of… more
- R1 RCM (Austin, TX)
- …went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply ... to the positions entailed duties and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer… more
- Tarleton State University (Stephenville, TX)
- …and 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% Research, Scholarship, and Creative Activity: + Maintain an… more
- Guidehouse (Lewisville, TX)
- …and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up + Customer Service + Billing ... + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in all… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …concurrent audit/review to determine possible risks and opportunities to assist in appeals . + Assists and standards of policy development. Review and provide input ... during development of billing compliance standards; identify areas that may require written policies; obtain input from campus constituents on proposed billing compliance policies. + Provides and tracks required Billing Compliance training. Schedule trainings… more
- CVS Health (Austin, TX)
- …new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and ... contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. + Work hours will be… more
- KPH Healthcare Services, Inc. (Longview, TX)
- …complex or uncollectible accounts to management for further action. + Submit appeals /claim corrections as needed within timely filing limits. + Utilize billing ... software to maintain accurate and detailed records of all collection activities, including communication with payers and patients. + Payer projects as assigned. + Identify and report trends in claim denials and payment challenges. +… more