Assoc Specialist, Appeals & Grievances Virtual Hiring Event
Company: Molina Healthcare
Location: Las Vegas
Posted on: November 22, 2021
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
- Enters denials and requests for appeal into information system
and prepares documentation for further review.
- Researches issues utilizing systems and other available
- 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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