- Molina Healthcare (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 (Sioux City, IA)
- …requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with federal and state ... trends and prepares reports that identify root causes for Appeals, Grievances , and Provider Disputes. Recommends and implements process improvements to achieve… more
- Molina Healthcare (Cedar Rapids, IA)
- …that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + ... Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina… 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
- 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
- Molina Healthcare (Davenport, 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
- Carlisle Community School District (Carlisle, 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 ... analyzes staff effectiveness and evaluates all assistants. 7. Maintains discipline, adjusts grievances and works to increase morale and cooperation. 8. Performs such… more
- Molina Healthcare (Sioux City, IA)
- …in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the development/maintenance of Member ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… 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