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Assoc Specialist, Appeals & Grievances Virtual Hiring Event

Company: Molina Healthcare
Location: Las Vegas
Posted on: November 22, 2021

Job Description:

JOB DESCRIPTIONJob SummaryMolina Healthcare's Appeals & Grievances jobs are responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.KNOWLEDGE/SKILLS/ABILITIES

  • Enters denials and requests for appeal into information system and prepares documentation for further review.
  • Researches issues utilizing systems and other available resources.
  • Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.
  • Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
  • Determines appropriate language for letters and prepare responses to appeals and grievances.
  • Elevates appropriate appeals to the Appeals Specialist.
  • Generates and mails denial letters.
  • Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
  • Creates and/or maintains statistics and reporting.
  • Works with member services to resolve balance bill issues and other member complaints regarding providers.JOB QUALIFICATIONSRequired EducationHigh School Diploma or GED with at least two years of college or equivalent experience.Required Experience1 - 3 years' experience in the medical field including one year of customer service or provider service experience in a managed care setting.Preferred EducationAssociate in Arts DegreePreferred ExperienceClaims experience in a managed care setting (medical office or hospital claims experience may substitute).Preferred License, Certification, AssociationCompletion of a healthcare related vocational program in Managed Care or some other health care aspect providing a certificate at completion (i.e., Certified Coder, billing, medical assistant).To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.As part of Molina's response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.Technical requirementsAfter signing up, you will be sent an email with instructions on how to connect.Please be prepared to join the virtual interview from a quiet place using a desktop or mobile device with a working speaker, microphone, and camera. Check to see if your network connection can support an online session. A plugged in ethernet cable or a strong WiFi network signal will help avoid time delays during your conversation.What to prepare
    • ResumePreferred dress codeBusiness casual (dress pants/skirt, button down/blouse, optional tie)About Molina HealthcareMolina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in California, Florida, Illinois, Michigan, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Washington, Wisconsin and Puerto Rico. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.What is a virtual interview?Virtual interviews help employers connect with job seekers when they are not in the same physical location. Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.

Keywords: Molina Healthcare, Las Vegas , Assoc Specialist, Appeals & Grievances Virtual Hiring Event, Other , Las Vegas, Nevada

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