- Molina Healthcare (Fort Worth, TX)
- …treatment * Provides second level BH clinical reviews, BH peer reviews and appeals * Supports BH committees for quality compliance. * Implements clinical practice ... State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Merck (Austin, TX)
- …of patient enrollment process, payer coverage policies, prior authorization process, appeals process, patient support programs, and Hub operations to Field Access ... or reimbursement support * Strong knowledge of health insurance structures ( Medicare Part B, Medicaid, commercial) and related access processes, including benefit… more
- HCA Healthcare (Plano, TX)
- …is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as ... preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional medical/billing, medical payment posting, and/or… more
- Cognizant (Austin, TX)
- …billing, with strong knowledge of RARC and CARC codes. . Expertise in Medicare , Medicaid, Managed Care, and Commercial payer processes. . Deep understanding of ... reporting. . Excellent verbal and written communication skills for documentation and appeals . . Ability to meet productivity and quality standards in a fast-paced… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …and coding guidelines. + Reviewing medical coding claim denials for correction and appeals within the AthenaIDX and Enterprise Task Manager (ETM) systems as assigned ... Location:** El Paso **Preferred Qualifications:** + Extensive knowledge of HIPAA, Medicare and Medicaid guidelines and regulations evaluation and management coding… more
- Highmark Health (Austin, TX)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. + ... offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being… more
- Molina Healthcare (Austin, TX)
- …* Provides second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance. * Implements ... compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation… more
- Cardinal Health (Austin, TX)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- Elevance Health (Grand Prairie, TX)
- …weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare . + Participate in the pharmaceutical care management process through ... resolve issues related to member/provider complaints, claims processing issues and appeals . **Minimum requirements:** + PharmD from an accredited school of pharmacy… more
- R1 RCM (Austin, TX)
- …went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply ... extensive knowledge in the health insurance industry (Commercial Insurances, Medicare , Medicaid); health claims billing and/or Third-Party contracts, minimum of… more