- Houston Methodist (Houston, TX)
- …Department and provides prompt internal and external problem resolution. + Identifies denials trends and notifies department management to prevent future denials ... and further delay in payments. Makes recommendations for resolution. Pursues appeals when available. Initiates communication with coding team and clinical staff when… more
- Methodist Health System (Dallas, TX)
- …and review outstanding claims, focusing on those with no response or denials . Identify and rectify errors, discrepancies, and missing information to resubmit claims ... promptly and accurately. - Investigate and address claim denials promptly. Utilize knowledge of payor policies, medical coding guidelines, and billing regulations to… more
- Guidehouse (Lewisville, TX)
- …all denials taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non-clinical denials + Monitors all denials ... for trends and issues and reports findings to supervisor + Bills or re-bills claims as necessary + Ensures the client follows all state and federal rules and regulations both billing and HIPAA + Completes assigned special projects within the time frames given… more
- Actalent (Texas City, TX)
- …Skills + Certified Pharmacy Technician (CPhT). + Experience in pharmacy operations, appeals , managed care, claims processing, and handling denials . + Strong ... + Review submitted documentation and gather additional information to support the appeals process. + Forward completed cases to pharmacists for final determination.… 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 ... providers and apply benefit plan criteria in making decisions (approvals / denials ) or recommendations; clarify and explain pharmaceutical benefits and procedures. .… more
- Intermountain Health (Austin, TX)
- …levels, providers, clinical staff, compliance and the 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… 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… 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 ... as assigned. + Identify and report trends in claim denials and payment challenges. + Communicateasneededwithpatients about billing issues,including theresults… more