- 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 ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Molina Healthcare (Houston, TX)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Molina Healthcare (Fort Worth, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Molina Healthcare (Houston, TX)
- …**Provider No Surprise Act** cases outcomes. . * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... * At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. *… more
- Molina Healthcare (Austin, TX)
- …* Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides training, ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal ...proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager… more
- Houston Methodist (Houston, TX)
- …items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review...National Coverage Determination (NCD) + Competence in writing clinical appeals for medical necessity compliance or level… 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 ... and to complete the claim filing process. + Process appeals online or via paper submission. + Assist with...Word and Excel. **Campus:** HSC - El Paso **Department:** Medical Coding SOM ELP **Required Attachments:** Resume / CV… more
- HCA Healthcare (Plano, TX)
- …experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional medical /billing, medical ... the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- Urology Clinics of North Texas (Mesquite, TX)
- Oncology Accounts Receivable Specialist Job Details Job Location 1650 Republic Pkwy Ste 130, Mesquite, TX 75150 - Mesquite, TX Description Position:Oncology Accounts ... ManagerLocation:Urology Clinics of North Texas Position Summary: The Oncology Accounts Specialist is responsible for managing and resolving insurance and patient… more