- Texas Health Resources (Fort Worth, TX)
- …patients to prevent unexpected financial burdens. -Assists in resolving claim denials and explain Explanation of Benefits (EOBs) in easy-to-understand terms. ... -Utilizes online tools, databases, and insurance portals to ensure accurate eligibility verification. -Ensures a smooth patient experience by managing Financial Clearance Work queues and providing Good Faith Estimates (GFE). -Records and maintain accurate… more
- Houston Methodist (Houston, TX)
- …appropriate notification of issues that may result in service delays or denials . Handles add-ons, reschedules, and cancellations appropriately and as per department ... protocol. **SERVICE ESSENTIAL FUNCTIONS** + Uses excellent communication skills (verbal, non-verbal, written) to facilitate providing the highest quality service during every patient, physician, guest, employee, or other encounter. Responds promptly to… more
- Houston Methodist (Sugar Land, TX)
- …timeliness and expert skill while may result in service delays or denials . Handles add-ons, reschedules, and cancellations appropriately and as per department ... protocol. **SERVICE ESSENTIAL FUNCTIONS** + Provides care to patients visiting the clinic under the direct supervision of a Physician, Registered Nurse, or clinic leadership procedures. Complete pre-visit planning workflow prior to visit whenever possible,… more
- UTMB Health (Galveston, TX)
- …procedures * Responds to daily correspondence according to procedures * Identifies denials and underpayments for appeal * Reviews, research, and processes denied ... claims * Appeal claims as appropriate according to policies and procedures * Updates account information and documents as appropriate within Epic Resolute * Processes account adjustments according to policies/procedures * Issues payer and/or patient refunds… more
- TEKsystems (Plano, TX)
- Description Key Responsibilities: + Work payer rejections and denials , ensuring timely resolution and follow-up. + Process approximately 15-40 claims per day, ... depending on volume. + Support collections efforts by identifying and addressing outstanding claims. + Ensure compliance with all applicable regulatory guidelines, payer policies, and internal procedures. + Collaborate with internal teams to clarify… more
- Adecco US, Inc. (Austin, TX)
- …providers and apply benefit plan criteria in making decisions (approvals / denials ) or recommendations; clarify and explain pharmaceutical benefits and procedures. . ... May partner with others to gather additional information and / or to interpret clinical guidelines; act as a resource for others **Qualifications for the Pharmacy Technician:** . HS Diploma or GED . Texas Pharmacy Technician license . National CPhT license… more
- Robert Half Accountemps (Fort Worth, TX)
- …of medical coding, including ICD-10 standards. * Proficiency in handling insurance denials , appeals, and hospital billing processes. * Familiarity with Lytec and ... TriZetto billing platforms. * Competence in using Microsoft Office applications such as Word, Excel, and Outlook. * Exceptional organizational skills and attention to detail. * Ability to work independently while collaborating effectively with healthcare… more
- Intermountain Health (Austin, TX)
- …CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding review, audit findings, and appeal ... strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex internal and external coding… more
- Molina Healthcare (Houston, TX)
- …needed to properly evaluate the request. + Accurately enters on-line approvals or denials of requests. Authorized to make and carry out simple prior authorization ... requests within established policies and procedures. + Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices. + Identifies and reports… more
- San Antonio Behavioral Health (San Antonio, TX)
- …documented in patient's medical records. + Reviews notices of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when ... appropriate and assist with construction of appeal letters. + Tracks denial information for reporting to Quarterly UR Committee. + Maintains liaison with the Social Services department to facilitate timely discharge planning. + Enters complete and accurate… more