- TEKsystems (Richardson, TX)
- …the appeals and arbitration process for denied or underpaid claims , ensuring timely and accurate submissions. - Prepare compelling appeal letters, supporting ... medical necessity, and reimbursement methodologies to strengthen appeal arguments. Skills: Appeals , Claims , medical collections, Medical insurance, TDI, NSA,… more
- Elevance Health (Grand Prairie, TX)
- …normal channels. + Works with internal business partners (sales, member experience, claims , medical review, appeals , etc.) and external contacts within the ... as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Plan to Plan Service Specialists may support Home… more
- Elevance Health (Houston, TX)
- …pharmacists to introduce efficiencies or improved criteria documents based on claims issues, complaints, state recommendations or audits. + Coordinates with internal ... the United States when conducting utilization review or an appeals consideration and cannot be located on a US...times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring… more
- Elevance Health (Houston, TX)
- …resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. **How ... and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must… more
- Elevance Health (Arlington, TX)
- …resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary ... and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must… more
- Elevance Health (Grand Prairie, TX)
- …databases for analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance payments to providers ... preferably in healthcare insurance departments such as Grievance and Appeals , Contracting or Claim Operations, law enforcement; or any...times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring… more
- UT Health (TX)
- …position offered is a hybrid, full-time role with a salaried, exempt status. When working onsite , you will be based in the central hub of the Texas Medical Center ... both the employee and manager during the disciplinary process.Facilitates appeals of disciplinary action and provides counsel to involved partiesregardingprocedural… more