- Molina Healthcare (Augusta, GA)
- …Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member appeals and communicating resolution to members and provider (or ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers… more
- Molina Healthcare (Augusta, GA)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises ... benefits, and review of covered services + Responsible for contacting the member /provider through written and verbal communication. + Prepares Provider No Surprises… more
- Molina Healthcare (GA)
- …and Marketplace request authorization. Strongly prefer candidates with a background in appeals and grievances . Excellent computer multi-tasking skills and good ... resource for Utilization Management, Chief Medical Officer, Physicians, and Member /Provider Inquiries/ Appeals . + Provides training, leadership and mentoring… more
- Molina Healthcare (Macon, GA)
- … Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... development/maintenance of Member Materials. **Knowledge/Skills/Abilities** * Serves as an advocate for...subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …card distribution, accurate provider directories, performance on VBC contracts, benefit adjudication, appeals , and grievances . + Collaborate with the TPA to ... lead the team responsible for product and plan design, member engagement, member experience, and core administration....experience with a focus on engagement. HEALTH AND WELLNESS SPECIALIST : + Develop and implement health and wellness programs… more