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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.

Associate Specialist, Appeals & Grievances (Remote in Texas)

Molina Healthcare Texas Job ID 2010370
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JOB DESCRIPTION

Job Summary

Molina 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 Medicaid.

KNOWLEDGE/SKILLS/ABILITIES

  • Enters denials and requests for appeal into information system and prepares documentation for further review.
  • Researches issues utilizing systems and other available resources.
  • 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 QUALIFICATIONS

Required Education

High School Diploma or GED with at least two years of college or equivalent experience.

Required Experience

1 - 3 years’ experience in the medical field including one year of customer service or provider service experience in a managed care setting.

Preferred Education

Associate in Arts Degree

Preferred Experience

Claims experience in a managed care setting (medical office or hospital claims experience may substitute).

Preferred License, Certification, Association

Completion 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.

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: 10/15/2021

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