- PharmaCord (Austin, TX)
- …includes completing benefit investigations, tracking prior authorizations / denial appeals , and assisting patients or other callers/stakeholders through resolution ... to payers and HCPs to follow up on proper submission and/or outcome. Coordinates nurse teach with nurse educators, as applicable to program Supports adherence… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Austin, TX)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Molina Healthcare (San Antonio, TX)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment ... with knowledge of CPT/HCPCS codes, record review, chart audit, provider disputes, appeals , and 1500 & UB04 claim experience are highly preferred. Ability to… more
- HCA Healthcare (Plano, TX)
- …individual is recognized. Submit your application for the opportunity below:Registered Nurse Case Manager IP RehabMedical City Plano **Benefits** Medical City Plano ... may vary by location._** We are seeking a(an) Registered Nurse Case Manager IP Rehab for our team to...achieving department goals . Track and trend denial and appeals to identify issues and develop action plans for… more
- Molina Healthcare (San Antonio, TX)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Molina Healthcare (Houston, TX)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Molina Healthcare (Fort Worth, TX)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Robert Half Accountemps (Dallas, TX)
- …and processing of claim within 45 days from the date of service. Perform appeals for underpaid claims or claim denials as assigned by the Billing Manager. Procure ... needed. * Utilizes approved appeal form letters to submit appeals in accordance with billing office policies and procedures....medical or coding denials to the QA Department for nurse review and appeal. * Demands claims for secondary… more
- Sharecare (Austin, TX)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Select Medical (Dallas, TX)
- …+ Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and account retention. ... state licensure or eligibility for state licensure as a Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist required.… more
- Houston Methodist (Houston, TX)
- …analytics and real-time dashboards to proactively manage authorization workflows, appeals , and peer reviews. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies, ... programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more
