- TEKsystems (Houston, TX)
- …this is not the simple call - this is a follow up that's been re-routed to the appeals specialist to do in the depth review of the denial letter to determine the ... clients Skills revenue cycle appeal, revenue cycle specialist , denials specialist , appeals specialist , insurance follow up, root cause analysis, EHR,… 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
- Cognizant (Austin, TX)
- ** Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel and… 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 (Fort Worth, 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
- Healthfirst (TX)
- …Reduction, Termination, and Suspension of services. The end-to-end process requires the Specialist to independently: + Research issues + Quality of Care Experience + ... + Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that… more
- Molina Healthcare (San Antonio, 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
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... denial management and appeals process, as applicable, in collaboration with clinical team...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information utilizing various resources and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... management and appeals process in a collaborative environment with revenue cycle...of the following: + * CCS - Certified Coding Specialist (AHIMA) + * CPC - Certified Professional Coder… more
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