- Molina Healthcare (Bowling Green, KY)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides support ... **Essential Job Duties** + Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… more
- Molina Healthcare (KY)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to...subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and… more
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to...subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and… more
- Molina Healthcare (Louisville, KY)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- Molina Healthcare (Covington, KY)
- …and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. ... with the standards and requirements established by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal… more
- Molina Healthcare (KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to ... internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine Medicare ...claims appeals using support systems to determine Medicare appeal and claim outcomes. + Requests and reviews… more
- Cognizant (Frankfort, KY)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more