TopUSAJobs.com
This listing was posted on TopUSAJobs.
Manager, Appeals & Grievances
Location:
Louisville, KY
Description:
***Remote and must live in the United States*** JOB DESCRIPTION Job Summary Responsible for leading, organizing and directing the activities of the Provider Appeals Unit that is responsible for reviewing and resolving provider complaints and communicating resolution in accordance with the standards and requirements established by the Centers for Medicare and Medicaid - KNOWLEDGE/SKILLS/ABILITIES Manages staff responsible for the submission/resolution of provider inquiries, appeals and grievances for the Plan. - Ensures resolutions are compliant. Proactively assesses and audits business processes to determine those most effective and efficient at resolving provider problems. Serves as primary interface with stakeholders and business partners and ensures standard processes are implemented. Oversees preparation of narratives, graphs, flowcharts, etc. to be used for committee presentations, audits and internal/external reports; oversees necessary correspondence in accordance with regulatory requirements. Maintains call tracking system of correspondence and outcomes for provider appeals; oversees monitoring of each member submission/resolution to ensure all internal and regulatory timelines are met. Managing regulatory complaints - JOB QUALIFICATIONS REQUIRED EDUCATION: Bachelor's degree or equivalent experience REQUIRED EXPERIENCE: Min. 6 - years' experience in healthcare claims review and/or member dispute resolution. 2 years leadership experience Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing). - 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. #PJClaims Pay Range: $54,373.27 - $117,808.76 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Company:
Molina Healthcare
Posted:
May 6 on TopUSAJobs
Visit Our Partner Website
This listing was posted on another website. Click here to open: Go to TopUSAJobs
Important Safety Tips
- Always meet the employer in person.
- Avoid sharing sensitive personal and financial information.
- Avoid employment offers that require a deposit or investment.
To learn more, visit the Safety Center or click here to report this listing.
More About this Listing: Manager, Appeals & Grievances
Manager, Appeals & Grievances is a Executive Manager Job at Molina Healthcare located in Louisville KY. Find other listings like Manager, Appeals & Grievances by searching Oodle for Executive Manager Jobs.
Manager, Appeals & Grievances is a Executive Manager Job at Molina Healthcare located in Louisville KY. Find other listings like Manager, Appeals & Grievances by searching Oodle for Executive Manager Jobs.