- Molina Healthcare (Houston, 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
- Texas Health Resources (Arlington, TX)
- Clinical Reviews, Denial and Appeals RN Bring your passion to THR so we are Better + Together Work location: Remote (Local candidates only) Work hours: Monday - ... or InterQual criteria required + Case management experience preferred + Denials and Appeals experience preferred + RN license to practice in the state of Texas… more
- Southwest Nursing Center (Fort Worth, TX)
- …billing and ensures that the Centralized Statement process is followed. + Manages Medicare ADRs and appeals per established procedure. + Other duties, ... responsibilities and activities may change or assigned at any time with or without notice. Southwest Nursing Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type… more
- Humana (Austin, TX)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to ... include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash… more
- J&J Family of Companies (Fort Worth, TX)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals /grievances); practice management; Medicare and Medicaid rules and ... regulations; OSHA; HIPAA; and state-specific clinical staff licensing / certification requirements for product compounding, admixture, administration and monitoring. Required Qualifications: + A minimum of a bachelor's degree + A valid driver's license issued… more
- UTMB Health (Galveston, TX)
- …calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible ... for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report… more
- Cognizant (Austin, TX)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Director based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/… more
- Cardinal Health (Austin, TX)
- …and evaluating strategic opportunities for all lines of business including Medicare , Medicaid, and various commercial markets. Key responsibilities include managing ... with stakeholders like pharmacies and PSAO leadership, and improving the MAC appeals process. This role is critical for ensuring fair pricing and adherence… 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. This ... and serves as the subject matter expert with all payers, including Medicare , Medicaid and commercial payers, and applicable department's revenue cycle operations.… more