- Molina Healthcare (Lexington, 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...of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid claims denials and appeals processing, and… more
- Molina Healthcare (Owensboro, KY)
- …for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business ... regulatory requirements. * Monitors and reports network adequacy for Medicare and Medicaid services. * Develops strategies to improve EDI/MASS rates. * Educates and… more