RenoRecruiter Since 2001
the smart solution for Reno jobs

Specialist, Appeals & Grievances Virtual Hiring Event

Company: Molina Healthcare
Location: Reno
Posted on: November 22, 2021

Job Description:

Job SummaryResponsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is 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 MedicaidKNOWLEDGE/SKILLS/ABILITIES

  • Responsible for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies.
  • Researches issues utilizing systems and clinical assessment skills, knowledge and approved "Decision Support Tools" in the decision making process regarding health care services and care provided to members.
  • Requests and reviews medical records, notes, and/or detailed bills as appropriate; evaluates for medical necessity and appropriate levels of care; formulates conclusions per protocol and collaborates with Medical Directors and other team members to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines.
  • Prepares appeal summaries, correspondence and documents information for tracking/trending data; assists in the preparation of narratives, graphs, flowcharts, etc. for presentations and audits.JOB QUALIFICATIONSRequired Experience
    • Min. 1 year utilization review experience and 1 year managed care experience.
    • Claims processing background, including coordination of benefits, subrogation, and eligibility criteria.
    • Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of NCQA guidelines for appeals and denials.Preferred EducationAssociate's or bachelor's degreePreferred License, Certification, AssociationLVN/LPN or completion of other healthcare related vocational program with certification (e.g., 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, Reno , Specialist, Appeals & Grievances Virtual Hiring Event, Other , Reno, Nevada

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Nevada jobs by following @recnetNV on Twitter!

Reno RSS job feeds