- Cognizant (Austin, TX)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Molina Healthcare (San Antonio, TX)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Molina Healthcare (Austin, TX)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Robert Half Accountemps (Dallas, TX)
- …and processing of claim within 45 days from the date of service. Perform appeals for underpaid claims or claim denials as assigned by the Billing Manager. Procure ... needed. * Utilizes approved appeal form letters to submit appeals in accordance with billing office policies and procedures....medical or coding denials to the QA Department for nurse review and appeal. * Demands claims for secondary… more
- Select Medical (Dallas, TX)
- …+ Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and account retention. ... state licensure or eligibility for state licensure as a Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist required.… 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 ... parties. + Maintain communication with doctors, attorneys, safety specialists, nurse specialists, and vendors. Provide prompt, economical, and professional handling… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more