- Molina Healthcare (TX)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the ... requirements. + Maintains call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each… more
- Molina Healthcare (Austin, TX)
- …+ Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, ... management with direct impact on Claims Operations (adjudication, configuration, appeals / grievances , payment integrity, provider data). **Preferred… more
- Sharecare (Austin, TX)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... an exciting and innovative remote role newly created to provide meaningful support to members and their families through...payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management… more
- Guardian Life (Plano, TX)
- …compliant with applicable state regulations. You will ensure that claims, referrals, appeals , and grievances meet state specific regulations, timeframes, and ... definitions for compliance. You will provide quality oversight and report any quality-of-care issues. In addition, the State Dental Director will be expected to lend… more
- Molina Healthcare (TX)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines… more
- Elevance Health (Grand Prairie, TX)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... or any combination of education and experience, which would provide an equivalent background. + Current State Pharmacy Tech...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more