- CVS Health (TX)
- …of experience in research and analysis of claim processing. - 1-2 years Medicare part C Appeals experience. **Education:** - High School Diploma **Anticipated ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- CenterWell (Austin, TX)
- …and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS… more
- Molina Healthcare (San Antonio, TX)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive… more
- Guidehouse (Lewisville, TX)
- …and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service ... + Billing + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and… more
- Molina Healthcare (Houston, TX)
- …We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work hours are Monday-Friday 8:00am- ... 5:00pm PST. This position included rotating weekends and holidays is required. Remote position **Essential Job Duties** * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and… more
- Molina Healthcare (TX)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and ... requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available… more
- Humana (Austin, TX)
- …our caring community and help us put health first** The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex… more
- Elevance Health (Plano, TX)
- **Referral Specialist I/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - Paragon Infusion** **Location:** 3033 W President George Bush HWY., STE ... information if necessary. + Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy. + Ability to read and… more
- Molina Healthcare (Dallas, TX)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... Outpatient Prospective Payment Systems, etc. + Stays informed of the latest Medicare , Medicaid and commercial payor news, updates, and regulations and adjusts… more
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