- Molina Healthcare (Austin, TX)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more
- CVS Health (Austin, TX)
- …meetings when required. + Understands and can respond to Executive complaints and appeals , Department of Insurance , Department of Health or Attorney General ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Elevance Health (Grand Prairie, TX)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... implications for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to… more
- Baylor Scott & White Health (Dallas, TX)
- …handling Responsibility for the preparation of summaries and files for denials, appeals , medical opinions, subrogation and litigation.1. Collection of documents ... for the approval of lost wages for payroll and for all approvals of medical bills per claim file.Pay and process claims within designated authority levelPerforms… more
- Humana (Austin, TX)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- Guidehouse (Lewisville, TX)
- …office and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up + Customer Service ... + Billing + UB-04 claims + Complete all business-related requests and correspondence from...creating a diverse and supportive workplace. Benefits include: + Medical , Rx, Dental & Vision Insurance +… more
- Houston Methodist (Houston, TX)
- …impacting AR collections. **FINANCE ESSENTIAL FUNCTIONS** + Expedites and maximizes payment of insurance medical claims by contacting third party payers and ... responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
- CenterWell (Austin, TX)
- …help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims . The Medical Director, Primary Care ... an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims . The Medical Director work… more
- MD Anderson Cancer Center (Houston, TX)
- …denials and identify possible avenues of appeal. * Contact third-party payers, insurance medical directors, case management, and utilization review to request ... clinical nursing experience. * Preferred: Nurse Defense Audit experience, experience with insurance appeals , prior case management or business office experience.… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …office operations, preferably in the medical office field. Knowledge of medical insurance terminology. + Ability to interact and communicate effectively with ... Excel, medical practice management software programs, and navigation of insurance provider portals for verification of eligibility and benefits and claim status… more