• Specialist , Appeals…

    Molina Healthcare (Lowell, MA)
    …+ 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
    Molina Healthcare (10/03/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
    Commonwealth Care Alliance (08/20/25)
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  • Appeals and Grievances Program…

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
    Commonwealth Care Alliance (09/05/25)
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  • Medicare/Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... resolve reimbursement concerns. + Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG,… more
    Commonwealth Care Alliance (08/31/25)
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