- Molina Healthcare (Green Bay, WI)
- …Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. ... tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each member submission/resolution to ensure… more
- Molina Healthcare (WI)
- …**Essential Job Duties** + Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. + Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Racine, WI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (WI)
- …+ 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 (Kenosha, WI)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… more
- Molina Healthcare (Kenosha, WI)
- …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
- Molina Healthcare (Madison, WI)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Cognizant (Madison, WI)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Evolent (Madison, WI)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances /complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of… more
- Molina Healthcare (Milwaukee, WI)
- …Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances , and payment integrity. + Technology Enablement: Oversee ... understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, NCQA, state regs). +… more