- Molina Healthcare (Rochester, NY)
- …+ 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
- City of New York (New York, NY)
- …with beneficiaries to answer questions and clarify Medicare Advantage plan specifics. Appeals and Grievances Support: - Assist beneficiaries in understanding ... older adults, community partners, and other groups on Medicare, Medicaid , Medigap, Elderly Pharmaceutical Insurance Coverage (EPIC), and Medicare's...to join our team as a Health Benefits Information Specialist . In this role, you will be tasked to… more
- Molina Healthcare (New York, NY)
- …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