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Molina Healthcare: Associate Representative, Intake/Triage Appeals & Grievances

Molina Healthcare

This is a Full-time position in Syracuse, NY posted June 29, 2020.

Job Description Job Summary Appeals & Grievances staff are responsible for the intake and triage of provider appeals, provider disputes, member appeals and member grievances.They upload, coordinate, assign and reroute cases receivedwithin timely and in compliance with all regulatory requirements.

Knowledge/Skills/Abilities Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.

Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider/member problem areas.

Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.

Interfaces with other departments regarding questions about provider/member configuration or other relevant provider/member issues.

Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals, provider disputes, and member grievances.

Monitors each request to ensure all internal and regulatory timelines are met.

Responsible for reviewing faxes/mail and reroute mail accordingly.

Handles additional tasks upon request.

Job Qualifications Required Education High School diploma or GED equivalent Required Experience 1-2 years experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience.

Preferred Education Associate’s Degree in Business and/or completion of a vocational program in Managed Care or some other health care aspect providing a certificate at completion.

Preferred Experience 1 2 years experience in a managed care setting Good communication skills; written and oral Experience in research and resolution is a plus Knowledge of claims to include a good understanding of service types, coding, provider specialties, etc Experience with Nitro Pro Strong organizational skills Ability to read and interpret policies and procedures Preferred License, Certification, Association CPC certification 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.