- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- Molina Healthcare (San Antonio, TX)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- 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 ... + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more
- Insight Global (Irving, TX)
- …pharmacy services. This role focuses on patient outreach, medication refills, insurance coordination, and appeals , ensuring seamless communication and support ... Conduct refill calls and manage prescription workflows Coordinate with insurance companies to obtain claims and run tests Draft...to obtain claims and run tests Draft and submit appeals for denied claims Perform patient outreach via phone… more
- Humana (Austin, TX)
- …+ Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. ... paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 10-31-2025 **About us**… more
- Urology Clinics of North Texas (Mesquite, TX)
- …and identify billing errors and resubmit claims to insurance carriers + Review insurance EOB and initiate appeals and as necessary + Respond to Payer's ... for a customer-focused office professional to perform collections, filing claims, handle appeals , and correspondence with payers. This position will focus on claims… more
- Houston Methodist (Cypress, TX)
- …etc. on insurance /managed care benefits + Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to ... information and database or directories elated to post-acute providers and insurance contacts to facilitate timely communication and coordination as needed **FINANCE… more
- Select Medical (Dallas, TX)
- …of follow up services and appointments at the time of discharge. + Obtains insurance authorizations and appeals denials as needed + Works collaboratively with ... beyond our doors. + Small Caseloads + Health, Dental, and Vision insurance ; Life insurance ; Prescription coverage. + Paid Time Off (PTO) and Extended Illness… more
- Highmark Health (Austin, TX)
- …could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of… more
- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. ... in dealing with patients and insurance companies. + Understanding of insurance contractual agreements, payer policies, guidelines and appeals process. +… more