Appeal Resolution Manager jobs in Lubbock, TX

Were excited youre considering joining a great place to work!

Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer.

All qualified applicants are encouraged to apply and will receive consideration for employment without regard to age, race, color, national origin, religion, sex, gender identity, sexual orientation, genetic information, veteran status, or any other basis protected by local, state, or federal law.

About this Position

At Texas Mutual Insurance Company, we are working together to create a stronger, safer Texas! You can join us, one of the best companies to work for in Texas, as a Medical Bill Resolution Specialist.

In this role, you will review and analyze medical bills for processing, negotiate with healthcare providers and approve payments.

You will report to the Medical Operations Supervisor.

Texas Mutual offers great benefits including career development training, three weeks accrued vacation, 401K match, paid time to volunteer in the community, and a modern sit / stand workstation.

See additional benefit details listed below!

Come join our team, grow your career, and be a part of making a difference in Texas and for Texas!

Responsibilities & Qualifications

What you can expect :

• Enjoy our hybrid / flex work opportunity which includes working from home and having the opportunity to collaborate in the office.
• Enjoy the opportunity to work remote up to ten days per year from anywhere in the U.S.
• You will have the option to report to one of our four office locations in either Austin, Dallas, Houston or Lubbock.

In this Role :

• Negotiate medical bills with healthcare providers and process payments for settlements.
• Process payments for providers, facilities, vendors, and contractors using multiple systems supporting these processes.
• Respond to medical dispute resolution requests by compiling support and analysis.
• Respond to Compliance and Practice requests, provider network grievances and records requests by reviewing historical billing and claim files, compile documentation and preparing a case summary.
• Maintain appropriate tracking and logging of all medical bill review, dispute processes and other work completed as determined by the department.
• Work with claim operations, provider network team, nurse case managers, and medical directors on claim files and billing trends.
• Stay current with CMS billing guidelines and upcoming changes.

Required Qualifications :

• High school diploma or equivalent education, training, or experience.
• At least two years of experience in medical billing, coding or utilization review or equivalent education, training, or experience.
• Knowledge of medical terminology as it relates to the processing of medical bills.

Preferred Qualifications :

• Certified Professional Coder (CPC) preferred.
• Certified Professional Medical Auditor (CPMA) preferred.
• Working knowledge of CMS billing manuals, fee schedules and pricers.

Flex-Hybrid Work Environment :

Texas Mutuals flex-hybrid schedule allows you to bring your best self to work by working remotely and collaborating in the office based on business needs.

All Texas Mutual employees are required to have Texas residency and travel to their designated office as needed.

Our Benefits :

Flex-hybrid work environment for most positions

Annual performance bonus and merit-based pay increase

Professional development and tuition reimbursement

Automatic 4% employer contribution to retirement plan

401k plan with 100% employer match up to 6%

Three weeks time off for vacation

Nine paid holidays and two personal days each year

Generous sick, holiday and volunteer time off

Day one health, Rx, vision and dental insurance

Life and disability insurance

Flexible spending account

Pet coverage and pet Rx discounts

Free on-site gym, fitness classes, and health and wellness resources

Free identity theft protection

Free 2nd medical opinion service

Free student loan repayment and refinancing consultation

Employee referral bonus

Last updated : 2024-03-26