- Molina Healthcare (Des Moines, IA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Molina Healthcare (Cedar Rapids, IA)
- …assist with research. + Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Humana (Des Moines, IA)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and… more
- Humana (Des Moines, IA)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage… more
- Molina Healthcare (Sioux City, IA)
- …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... 2. Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic… more
- Molina Healthcare (Davenport, IA)
- …and independent contracting, down line broker applications commissions, Broker Agent appeals / grievances , educating Brokers on plan benefits in all markets, ... Oversees the detailed process of broker commission reconciliation * Handles Broker Agent appeals / grievances . * Educates Brokers on plan benefits in all markets.… more
- Molina Healthcare (Cedar Rapids, IA)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… more
- Access Dubuque (Dubuque, IA)
- …to internal processing guidelines. + Assist in review and resolution of complaints, appeals and grievances as needed. + Complete all additional assigned projects ... and duties. **Knowledge, Skills and Abilities:** _Experience:_ One to three years of similar or related experience. _Education:_ High school diploma or GED required. _Other Skills:_ Excellent telephone presence. Familiar with Microsoft Office applications,… more
- UnityPoint Health (Des Moines, IA)
- …employee relations problems, such as working conditions, disciplinary actions, and employee appeals and grievances . + Responds effectively to employee relations ... queries, including questions on policies and practices. + Serve as Common Ground facilitator + Recognizes patterns and anticipates employee-related issues; develops, recommends, and initiates appropriate steps for resolution in accordance with policies and… more
- Highmark Health (Des Moines, IA)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more