Specialist, Appeals & Grievances (Must reputed company in Central Time Zone)

Job reputed company Job reputed company Responsible for reviewing and resolving member and provider complaints and communicating reputed company to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and reputed company Knowledge/Skills/Abilities • Responsible for the comprehensive research and reputed company of the appeals, dispute, grievances, and/or complaints from Molina members, providers and reputed company reputed company agencies to ensure that internal and/or regulatory timelines are met. • Research claims appeals and grievances using support systems to determine appeal and grievance reputed company. • Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and reputed company guidelines. • Responsible for meeting production standards set by the department. • Apply contract language, benefits, and review of covered services • Responsible for contacting the member/provider through written and verbal communication. • Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. • Composes reputed company correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. • Research claims processing guidelines, provider reputed company, fee schedules and system configurations to determine reputed company cause of payment error. • Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from reputed company agencies Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalency Required Experience • Min. 2 years operational managed care experience (reputed company center, appeals or claims environment). • Health claims processing background, including coordination of benefits, subrogation, and eligibility reputed company. • Familiarity with reputed company and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. • Strong verbal and written communication skills To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $21.16 - $38.37 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job