Molina Healthcare

Sr Specialist, Appeals & Grievances

  • Molina Healthcare
  • Bothell, WA 98021
  • 12 days ago

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Job Description

JOB DESCRIPTION

Job Summary

Responsible for oversight regulatory agency complaints and grievances to ensure timely and accurate responses.

KNOWLEDGE/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.

Responsible for reviewing regulatory agency complaint responses by the Appeals & Grievances team.

Created and provided variety of training for staff.

Facilitating meetings with Premium Billing as needed

Creating and/or updating policy and procedures as needed.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED.

Required Experience

Min. 2 years managed care experience.

Min. 2+ years of Claims knowledge

Familiarity with Medicaid and Marketplace benefits and claim processing.

Required License, Certification, Association

N/A

Preferred Education

Associate's or bachelor’s degree

Preferred License, Certification, Association

N/A

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.

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