- Molina Healthcare (Ann Arbor, MI)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist. This position is remote and will be working Pacific Standard hours. Highly Qualified ... Duties** * Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside… more
- Molina Healthcare (Grand Rapids, MI)
- …Duties** + Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside ... and/or regulatory timelines are met. + Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.… more
- Molina Healthcare (Detroit, MI)
- …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
- Cognizant (Lansing, MI)
- **Member Appeals & Grievances Specialist** (remote) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** We are ... Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances , processes, resolutions, compliance TAT Self-resolved troubleshooting ability for… more
- Molina Healthcare (Grand Rapids, MI)
- …Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the next level for review. * ... an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services… more
- Molina Healthcare (Ann Arbor, MI)
- …for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. + Proactively assesses ... tracking system of correspondence and outcomes for provider and member appeals/ grievances ; oversees monitoring of each member submission/resolution to ensure all… more
- Molina Healthcare (Ann Arbor, MI)
- …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
- Molina Healthcare (Warren, MI)
- …**Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and… more
- Highmark Health (Lansing, MI)
- …RESPONSIBILITIES** + Effectively triage, investigate, resolve and document complaints and grievances while ensuring adherence to the Patient Bill of Rights, ... regulatory requirements and network policy Patient Complaints, Grievances and Compliments. Analyze complaints and grievances data and report trends and/or… more
- McLaren Health Care (Detroit, MI)
- …in this position will serve as the point of contact for complaints, grievances , and concerns. Additionally, the Patient Experience Manager will assist in providing ... contact with patients, providers, and staff regarding patient rights, complaints/ grievances , and service recovery. 3. Communicate, mediate, investigate, and document… more