- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... to make appropriate decisions and is accountable for reviewing denials for level of care, medical necessity,...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information… more
- Molina Healthcare (San Antonio, TX)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for… more
- Molina Healthcare (Fort Worth, TX)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... appeals and denials . + Strong verbal and written communication skills To… more
- Molina Healthcare (Houston, TX)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Surprise Act** cases outcomes. . * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... appeals and denials . * Customer service experience. * Strong organizational and… more
- Molina Healthcare (Houston, TX)
- …Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
- HCA Healthcare (Plano, TX)
- …We want your knowledge and expertise! **Job Summary and Qualifications** The Clinical Denials Coding Review Specialist is responsible for applying correct coding ... experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional medical /billing, medical … more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- **43131BR** **Extended Job Title:** Medical Billing Specialist **Org Level 1:** Texas Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for ... timely submission of claims, monitoring claim status, investigating claim denials /rejections, and documenting related account activities. **Requisition ID:** 43131BR… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …staff on documentation and coding guidelines. + Reviewing medical coding claim denials for correction and appeals within the AthenaIDX and Enterprise Task ... **43114BR** **Extended Job Title:** Coding Specialist **Org Level 1:** Texas Tech Unv Hlth...Unv Hlth Sci Ctr El Paso **Position Description:** Review medical record provider documentation and assign appropriate CPT, HCPCS… more
- KPH Healthcare Services, Inc. (Longview, TX)
- **Overview** The Revenue Cycle Management Specialist - Collections responsibility is to ensure timely collection of outstanding balances. **Responsibilities** + ... complex or uncollectible accounts to management for further action. + Submit appeals /claim corrections as needed within timely filing limits. + Utilize billing… more