- Molina Healthcare (South Charleston, OH)
- …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
- Elevance Health (Mason, OH)
- …delegated Healthcare Vendors (Vision, Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + ... **Vendor Implementation Manager ** **Hybrid 1:** This role requires associates to...enhancement and issue management for multiple states and for Medicaid and Medicare lines of business. **How You Will… more
- CVS Health (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Insight Global (Mayfield Heights, OH)
- …Authorization/Gold Carding, Eligibility/Benefits Verification, Claim Submission, Adjudication, Payment, Appeals / Grievances ) * Clear and confident communicator, ... preparation and execution of User Acceptance Testing * Assist the project manager in developing the requirements phase plan and develop the requirements management… more