Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Molina Healthcare. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. Job Description Candidates must be based in Florida.
********Job SummaryResponsible for reviewing and resolving member & provider 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/AbilitiesEnters denials and requests for appeal into information system and prepares documentation for further review. Research 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 provider & member services to resolve balance bill issues and other member/provider complaints. Job QualificationsREQUIRED EDUCATION: High School Diploma or equivalencyRequired Experience1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment. Strong verbal and written communication skills.
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 - $34. 88 / HOURLYActual compensation may vary from posting based on geographic location, work experience, education and/or skill level. If you have questions about this posting, please contact support@lensa. com
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