- Molina Healthcare (Atlanta, GA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Intermountain Health (Atlanta, GA)
- …the formulary transition process. + Assists Medicare and Medicaid members with grievances , coverage determination (including exceptions), and appeals process. + ... **Job Description:** The Pharmacy Government Specialist II is responsible for the day-to-day operations...call flow as well as established auditing criteria. The Specialist II stays current and conversant on general plan… more
- Molina Healthcare (Atlanta, GA)
- …for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… more