- Molina Healthcare (Detroit, MI)
- …+ 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 and Medicare claims denials and appeals … more
- Molina Healthcare (Warren, MI)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- Area Agency On Aging 1-b (Southfield, MI)
- … and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and accreditation ... Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual,...experience in an administrative clinical setting, including 1-2 years Medicaid managed care appeals process & Health/Human… more
- Cognizant (Lansing, MI)
- …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
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