- Molina Healthcare (Atlanta, GA)
- …Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for developing and ... oversight and monitoring of the teams responsible for triaging member complaints, appeals and provider disputes in accordance with state regulations, federal… more
- Molina Healthcare (Atlanta, GA)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... Provides direct oversight, monitoring and training of local plans' provider dispute and appeals units to ensure...training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- Molina Healthcare (Atlanta, GA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Molina Healthcare (Atlanta, GA)
- …for claims payment); Provider /Member Inquiry Research and Resolution; and Provider /Member Appeals and Grievances . * Coordinates with Corporate ... in the United States _** **Job Description** **Job Summary** Molina's Provider Contracting function provides guidance, signature support services, standards and… more
- Highmark Health (Atlanta, GA)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL… more