- HCA Healthcare (Austin, TX)
- …UT, VA). Do you want to join an organization that invests in you as a Appeals Specialist ? At Parallon, you come first. HCA Healthcare has committed up to $300 ... have the opportunity to make a difference. We are looking for a dedicated Appeals Specialist like you to be a part of our team. **Job Summary and… more
- TEKsystems (Austin, TX)
- Overview We are seeking a highly analytical and proactive Revenue Cycle Appeals Specialist to join our team. This role is ideal for someone with strong ... experience in appeals , denials, and insurance follow-up within the healthcare revenue...cause analysis to determine next steps. 2. Rebilling & Appeals Submission + Focus on claims ready for appeal-already… more
- Molina Healthcare (Austin, TX)
- …for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Molina Healthcare (Austin, TX)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Molina Healthcare (Austin, TX)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... analyses of advocacy issues; and assists with documentation preparation for appeals , fair hearings or other formal/informal dispute resolution process. * Provides… more
- Ascension Health (Austin, TX)
- …Responsible for reviewing, investigating and resolving health-care claim payment appeals and communicating resolution/determination in accordance with the standards ... guidelines. + Responsible for the comprehensive research and resolution of claim appeals from health-care providers and related outside agencies to ensure that… more
- CVS Health (Austin, TX)
- …**Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all… more
- Intermountain Health (Austin, TX)
- …providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding ... review, audit findings, and appeal strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex… more
- Cardinal Health (Austin, TX)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
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