- Molina Healthcare (Chandler, AZ)
- …* Manages team responsible for the submission/resolution of member and provider appeals and grievances ; ensures resolutions are compliant with applicable ... system of correspondence and outcomes for provider and member appeals / grievances ; oversees/monitors appeals to ensure...complicated claims, COB and DRG/RCC pricing). * Experience with Medicaid and Medicare claims denials and appeals … more
- CVS Health (Phoenix, AZ)
- …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making + Experience dealing with state or federal regulators + Excellent written and verbal communication skills and… more
- Molina Healthcare (Mesa, AZ)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more