• Director, Appeals & Grievances (Remote)

    Molina Healthcare (Dallas, TX)
    …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and ... **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and resolving… more
    Molina Healthcare (09/26/25)
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  • IRT Appeals Representative

    Humana (Austin, TX)
    …a part of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and ... documentation to determine if an appeal or further request is warranted. The Appeals Representative 4 IRT (Internal Review Team) + Review documents + Building cases… more
    Humana (10/10/25)
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  • Grievances and Appeals 3

    CenterWell (Austin, TX)
    …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
    CenterWell (10/08/25)
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  • Medical Director - Medicare Grievances…

    Humana (Austin, TX)
    …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
    Humana (10/02/25)
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  • Corporate Medical Director - Medicare Grievances…

    Humana (Austin, TX)
    …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
    Humana (09/05/25)
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  • Follow Up Associate II, Cash Posting

    R1 RCM (Austin, TX)
    …AI, intelligent automation, and workflow orchestration Job Description The Follow Up Associate II rep will be responsible for investigating and examining denial ... 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… more
    R1 RCM (08/19/25)
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  • Associate Director of Finance - Government…

    UTMB Health (Galveston, TX)
    Associate Director of Finance - Government Reimbursement **Galveston, Texas, United States** Executive - Business Professional UTMB Health Requisition # 2504131 ... **Summary:** The Associate Director ensures accurate and appropriate government payor reimbursement-related...but not limited to, cost report preparation, audits, re-openings, appeals , IME, DGME, DSH, UC, Organ Acquisition, Bad Debt,… more
    UTMB Health (08/08/25)
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  • Business Integrity Associate

    Meta (Austin, TX)
    …Job" online on this web page. **Required Skills:** Business Integrity Associate Responsibilities: 1. Develop compelling analyses to execute data-informed initiatives ... tradeoffs 13. 4. Operational process development with end-to-end enforcement- appeals infrastructure process, policy/process development, escalations and investigations of… more
    Meta (09/26/25)
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  • Claims and Litigation Specialist

    Ascension Health (Austin, TX)
    …Responsible for reviewing, investigating and resolving health-care claim payment appeals and communicating resolution/determination in accordance with the standards ... guidelines. + Responsible for the comprehensive research and resolution of claim appeals from health-care providers and related outside agencies to ensure that… more
    Ascension Health (08/29/25)
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  • Medical Director - Florida

    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
    Humana (10/03/25)
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