ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT
Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.
Specialist, Appeals & Grievances
Molina Healthcare Albany, New York; Owensboro, Kentucky; Michigan; Lexington-Fayette, Kentucky; Dallas, Texas; Iowa; Mesa, Arizona; Cincinnati, Ohio; Fort Worth, Texas; Roswell, New Mexico; St. Petersburg, Florida; Omaha, Nebraska; Rochester, New York; Dayton, Ohio; Bowling Green, Kentucky; Milwaukee, Wisconsin; Vancouver, Washington; Caldwell, Idaho; Albuquerque, New Mexico; Syracuse, New York; Florida; Rio Rancho, New Mexico; Cedar Rapids, Iowa; Atlanta, Georgia; Orlando, Florida; Akron, Ohio; Jacksonville, Florida; Houston, Texas; Bellevue, Nebraska; Las Cruces, New Mexico; Nebraska; Wisconsin; Warren, Michigan; Texas; Washington; Tampa, Florida; Des Moines, Iowa; Grand Island, Nebraska; Nampa, Idaho; Davenport, Iowa; Ann Arbor, Michigan; Orem, Utah; Madison, Wisconsin; Kentucky; Meridian, Idaho; Columbus, Georgia; Savannah, Georgia; Kearney, Nebraska; Santa Fe, New Mexico; Scottsdale, Arizona; New Mexico; Louisville, Kentucky; Boise, Idaho; Lincoln, Nebraska; Covington, Kentucky; Bellevue, Washington; Grand Rapids, Michigan; Utah; Ohio; Kenosha, Wisconsin; Macon, Georgia; Sioux City, Iowa; Tucson, Arizona; Tacoma, Washington; Green Bay, Wisconsin; Augusta, Georgia; San Antonio, Texas; Phoenix, Arizona; Cleveland, Ohio; Spokane, Washington; Buffalo, New York; Salt Lake City, Utah; Sterling Heights, Michigan; Georgia; New York; Provo, Utah; West Valley City, Utah; Detroit, Michigan; Racine, Wisconsin; Iowa City, Iowa; Layton, Utah; Everett, Washington; Austin, Texas; Idaho; Chandler, Arizona; Columbus, Ohio; Idaho Falls, Idaho; Yonkers, New York; Miami, Florida Job ID 2032904JOB DESCRIPTION
Job Summary
Responsible for reviewing and resolving Provider No Surprises Act cases in accordance with the standards and requirements established by the Centers for Medicare and Medicaid
KNOWLEDGE/SKILLS/ABILITIES
- Responsible for the comprehensive research and resolution of Provider No Surprises Act cases to ensure that internal and/or regulatory timelines are met.
- Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes.
- 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 Molina Healthcare 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 Provider No Surprises Act correspondence and document findings. Include information on trends if requested.
- Composes all correspondence and Provider No Surprises Act information concisely and accurately, in accordance with regulatory requirements.
JOB QUALIFICATIONS
REQUIRED EDUCATION:
High School Diploma or equivalency
REQUIRED EXPERIENCE:
- Min. 2 years operational managed care experience (call center, appeals or claims environment).
- Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria.
- Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for Provider No Surprises Act cases
- Strong verbal and written communication skills
PREFERRED EXPERIENCE:
- No Surprise Act Provider Disputes knowledge/experience
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.
Pay Range: $21.16 - $38.37 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type Full Time Posting Date 07/30/2025Job Alerts
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