- Molina Healthcare (Iowa City, IA)
- …of employees responsible for submission, intervention and resolution of appeals, grievances , and/or complaints from Molina members, providers and related outside ... provides guidance to others with respect to the more complex appeals and grievances . + Research and resolves escalated issues including state complaints and high… more
- Molina Healthcare (Sioux City, IA)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
- Molina Healthcare (Iowa City, IA)
- …Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist. + Generates ... and mails denial letters. + Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. + Creates and/or maintains statistics and reporting. + Works with provider & member services to resolve balance bill issues… more
- Healthfirst (IA)
- …+ Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case management. + ... Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as… more
- Humana (Des Moines, IA)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Humana (Des Moines, IA)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
- Molina Healthcare (Des Moines, IA)
- …Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the ... standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for… more
- Molina Healthcare (Sioux City, IA)
- …must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You surface systemic issues, ... Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic defects. 3. Capabilities… more
- BioLife Plasma Services (Des Moines, IA)
- …BioLife business. + Analyzes trends in turnover, hiring, promotion, separation, grievances , etc. to recommend preventative actions needed to adjust unfavorable ... exit interviews, analyze trends in turnover, hiring, promotions, separations and grievances to determine support or action needed to adjust unfavorable trends;… more
- Fort Dodge Community School District (Fort Dodge, IA)
- …the proper administrative line of command and refers all requests or grievances through proper channels. Is aware of all public/staff/departmental meetings that ... programs, services, and its employment practices. If you have questions or grievances related to this policy, please contact Roger Porter, Director of School… more