- Molina Healthcare (WI)
- …+ 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 (Green Bay, WI)
- …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
- Cognizant (Madison, WI)
- …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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