Specialist jobs at Molina Healthcare - 34 jobs

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / 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.

Responsible for providing telephonic patient counseling, nursing intervention with some support to physicians and coordination and delivery of reimbursement and other services related to the patient support programs. May be responsible for the coordination and delivery of services related to the patient support programs. Involves interactions with patients, physicians and other health care professionals and members of multidisciplinary team using web based, telephony and face to face means of communication. CAREER LEVEL DESCRIPTION: Experienced, fully competent in own area covering a wide range of tasks. Completes own role independently or with minimal supervision. KNOWLEDGE: Complete understanding of the general and technical aspects of the job. PROBLEM COMPLEXITY: Provides resolutions to a wide range of problems. Job requires judgement within defined policies and practices. MINIMUM EDUCATION & TYPICAL EXPERIENCE OR EQUIV. COMBINATION: Works with limited autonomy and under moderate direction. Routine work requires no direction. Work is evaluated upon completion to ensure objectives have been met. CAREER LEVEL: B3 Additional Information All your information will be kept confidential according to EEO guidelines.

Salary Estimate: 42764.80 - 59862.40 / year Learn more about the benefits offered for this job. The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. You Can Change the Life of One to Care for the Lives of Many! At Galen College of Nursing, we educate and empower nurses to change lives. Since 1989, we've dedicated our work to delivering high-quality nursing education with a student-first mindset. As one of the largest private nursing colleges in the country, we combine the support of a close-knit learning environment with the strength of a nationally recognized institution, HCA Healthcare. That same passion for excellence in the classroom extends to our offices. At Galen, you'll find a culture deeply rooted in collaboration, innovation, and a shared commitment to improving the future of healthcare. Your work directly touches the next generation of nurses, and your contributions help our students pursue their dream of a compassionate career. If you're looking for a career where you can make a difference, grow professionally, and be part of a caring team, we'd love for you to apply for the Campus Engagement Specialist position today! Click here to learn more about Galen! Position Overview: As a Campus Engagement Specialist at Galen College of Nursing, you will coordinate campus and student engagement activities, as well as other related services to support student success in the nursing programs and career preparation. This position will collaborate with Galen's faculty, administration, and staff in addressing the needs of a student population with diverse academic, cultural, ethnic, and socioeconomic backgrounds. In addition, the Campus Engagement Specialist will organize career fairs, new student orientation and other campus events. Key Responsibilities: * Collaborate to organize and/or implement graduation and honor ceremony events, as required. * Organize and facilitate new student orientation. * Develop and facilitate career information workshops and career fairs to enhance student/graduate readiness for employment. * Collaborate with the nurse sponsor Galen Student Nurse Association and assist GSNA in planning quarterly programming, as required. * Facilitate the Student Advisory Committee. * Facilitates the Student Veteran's Association. * Recruits, trains, monitors, and coordinates the Student Ambassador and Peer Mentor programs. * Serve as the primary student point of contact for the Student Success Department. * Refers students in need of services to the appropriate Student Success Department staff. * Promote Student Success Department services within the campus. * Monitor, document, and report student utilization of department services * Participate in campus activities including committee work, and campus events. * Serve as the campus-level coordinator for internal investigations of ADA related grievances. * Collaborate with the 504 Coordinator, campus leadership, and Compliance and Regulatory Affairs to ensure that attempts to mediate and resolve complaints are made prior to formal grievance stage. * Assist the 504 Coordinator and campus leadership to ensure that ADA investigations and hearings are conducted according to policies and procedures. Position Requirements: * Education: Bachelor's degree in education, student affairs, social services, counseling, or related field preferred. * Special Qualifications: Microsoft Office computer skills, including Microsoft Word and Microsoft Excel competencies. Student information system program experience preferred. Excellent oral and written communication skills. Must present a professional demeanor and appearance. Must assist in a variety of complex administrative duties involving contact and exposure to proprietary information. Utilizes independent judgement, determining when to act for management and when to refer problems for personal attention. Must have dependable transportation for frequent local travel. Demonstrate dependability and attention to detail. Membership in a professional career services organization is a plus. Physical Requirements: Must be able to sit in front of a computer screen, lift up to 30 pounds, and sit, stand, or walk for extended periods of time. * Degree of Supervision: Minimal Benefits At Galen College of Nursing, we want to ensure your needs are met. We offer a comprehensive package of medical, dental, and vision plans, tuition discounts, along with unique benefits, including: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more. * Free counseling services and resources for emotional, physical, and financial well-being * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for children, elders, and pet care, home and auto repair, event planning, and more. * Consumer discounts through Abenity. * Retirement readiness, rollover assistance services, and preferred banking partnerships. * Education assistance (tuition, student loan, certification support, dependent scholarships). * Colleague recognition program. * Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence). * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits. Note: Eligibility for benefits may vary by location. Galen College of Nursing is recognized as a 2023 National League of Nursing (NLN) Center of Excellence (COE). Galen's Compassionate Care Model Values * Inclusivity: I foster an environment that provides opportunity for every individual to reach their full potential. * Character: I act with integrity and compassion in all I do. * Accountability: I own my role and accept responsibility for my actions. * Respect: I value every person as an individual with unique contributions worthy of consideration. * Excellence: I commit myself to the highest level of quality in everything I do. Learn more about our vision and mission. Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Campus Engagement Specialist Galen College of Nursing

Salary Estimate: $42764.80 - $59862.40 / year Learn more about the benefits offered ( ********************************************************************* ) for this job. The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. **You Can Change the Life of One to Care for the Lives of Many!** At Galen College of Nursing, we educate and empower nurses to change lives. Since 1989, we've dedicated our work to delivering high-quality nursing education with a student-first mindset. As one of the largest private nursing colleges in the country, we combine the support of a close-knit learning environment with the strength of a nationally recognized institution, HCA Healthcare. That same passion for excellence in the classroom extends to our offices. At Galen, you'll find a culture deeply rooted in collaboration, innovation, and a shared commitment to improving the future of healthcare. Your work directly touches the next generation of nurses, and your contributions help our students pursue their dream of a compassionate career. If you're looking for a career where you can make a difference, grow professionally, and be part of a caring team, we'd love for you to apply for the _Campus Engagement Specialist_ position today! Click here to learn more about Galen! (******************************* **Position Overview:** As a Campus Engagement Specialist at Galen College of Nursing, you will coordinate campus and student engagement activities, as well as other related services to support student success in the nursing programs and career preparation. This position will collaborate with Galen's faculty, administration, and staff in addressing the needs of a student population with diverse academic, cultural, ethnic, and socioeconomic backgrounds. In addition, the Campus Engagement Specialist will organize career fairs, new student orientation and other campus events. **Key Responsibilities:** 1. Collaborate to organize and/or implement graduation and honor ceremony events, as required. 2. Organize and facilitate new student orientation. 3. Develop and facilitate career information workshops and career fairs to enhance student/graduate readiness for employment. 4. Collaborate with the nurse sponsor Galen Student Nurse Association and assist GSNA in planning quarterly programming, as required. 5. Facilitate the Student Advisory Committee. 6. Facilitates the Student Veteran's Association. 7. Recruits, trains, monitors, and coordinates the Student Ambassador and Peer Mentor programs. 8. Serve as the primary student point of contact for the Student Success Department. 9. Refers students in need of services to the appropriate Student Success Department staff. 10. Promote Student Success Department services within the campus. 11. Monitor, document, and report student utilization of department services 12. Participate in campus activities including committee work, and campus events. 13. Serve as the campus-level coordinator for internal investigations of ADA related grievances. 14. Collaborate with the 504 Coordinator, campus leadership, and Compliance and Regulatory Affairs to ensure that attempts to mediate and resolve complaints are made prior to formal grievance stage. 15. Assist the 504 Coordinator and campus leadership to ensure that ADA investigations and hearings are conducted according to policies and procedures. **Position Requirements:** + Education: Bachelor's degree in education, student affairs, social services, counseling, or related field preferred. + Special Qualifications: Microsoft Office computer skills, including Microsoft Word and Microsoft Excel competencies. Student information system program experience preferred. Excellent oral and written communication skills. Must present a professional demeanor and appearance. Must assist in a variety of complex administrative duties involving contact and exposure to proprietary information. Utilizes independent judgement, determining when to act for management and when to refer problems for personal attention. Must have dependable transportation for frequent local travel. Demonstrate dependability and attention to detail. Membership in a professional career services organization is a plus. Physical Requirements: Must be able to sit in front of a computer screen, lift up to 30 pounds, and sit, stand, or walk for extended periods of time. + Degree of Supervision: Minimal **Benefits** At Galen College of Nursing, we want to ensure your needs are met. We offer a comprehensive package of medical, dental, and vision plans, tuition discounts, along with unique benefits, including: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more. + Free counseling services and resources for emotional, physical, and financial well-being + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for children, elders, and pet care, home and auto repair, event planning, and more. + Consumer discounts through Abenity. + Retirement readiness, rollover assistance services, and preferred banking partnerships. + Education assistance (tuition, student loan, certification support, dependent scholarships). + Colleague recognition program. + Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence). + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits. (*********************************************************************) _Note: Eligibility for benefits may vary by location._ Galen College of Nursing is recognized as a 2023 National League of Nursing (NLN) Center of Excellence (COE). (****************************************************************************************************************** **Galen's Compassionate Care Model Values** + Inclusivity: I foster an environment that provides opportunity for every individual to reach their full potential. + Character: I act with integrity and compassion in all I do. + Accountability: I own my role and accept responsibility for my actions. + Respect: I value every person as an individual with unique contributions worthy of consideration. + Excellence: I commit myself to the highest level of quality in everything I do. Learn more about our vision and mission (*********************************************** . Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. _Submit your application for the opportunity below:_ Campus Engagement Specialist Galen College of Nursing

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

This is a fully remote role, but you must live within 60 miles of an HCA facility Introduction Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Benefits HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CDI Reconciliation Specialist like you to be a part of our team. Job Summary and Qualifications Assessment of Documentation: * Performs high priority retrospective reviews of the complete medical record and the coding summary of assigned population. * Analyzes documented and clinically supported conditions in multiple electronic health record technologies to ensure complete documentation. * Performs independent coding of the record to assure that the HIM coding accurately reflects the documentation. * Ensures documented conditions, clarifications, and coded diagnoses are clinically supported. * As appropriate, enters or revises Working and Target DRGs that accurately reflect expected CDI query impact. * Demonstrates knowledge of Official Coding Guidelines and the DRG Classification System to insure regulatory compliance related to the CDI and coding functions. * Identifies and documents education opportunities for CDI Specialists * Thoroughly documents reviews and other pertinent information in designated systems by established deadlines. * Achieves and maintains key operating metrics consistent with CDI Reconciliation program requirements. HSC Escalation: * Using critical thinking skills, independent discretion, clinical judgement, Official Coding Guidelines, DRG Classification, and Coding Clinics determines when and/or if escalation to the HSC is necessary. * Escalates DRG mismatches with coding opportunities as appropriate per established protocols. * Monitors and documents HSC responses. Strategic Relationships: * Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients * Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships * Delivers information in a clear, concise and compelling manner to facilitate accomplishment of work goals * Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience * Demonstrates a willingness and ability to assist others Self-Development: * Demonstrates proficiency in current and emerging technologies * Simultaneously uses multiple technologies to complete unique patient-level reviews * Independently takes proactive steps toward problem resolution * Completes all mandatory and assigned education by established deadlines * Attends scheduled meetings and continuing education programs Education & Experience: * Bachelors degree required * 5+ years of experience in acute inpatient CDI or equivalent combination of education and/or experience required Licenses, Certifications, & Training: * Registered Nurse - Currently licensed as a Registered Professional Nurse in the state of residence * Or any coding credential nationally recognized as administered through AHIMA or ACDIS required * (CDIP) Certified Documentation Improvement Practitioner, or (RN) Registered Nurse, or (COC) Certified Outpatient Coder, or (CCS) Certified Coding Specialist, or (CPC) Certified Professional Coder, or (RHIA) Registered Health Information Administrator, or (RHIT) Registered Health Information Technician, or (ACDIS-CCDS) Certified Clinical Documentation Specialist HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleledresources and opportunitiesto reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education andcareer advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our CDI Reconciliation Specialist opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

This is a fully remote role but you must live within 60 miles of an HCA facility Introduction Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Benefits HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CDI Recon Specialist like you to be a part of our team. Job Summary and Qualifications Assessment of Documentation: * Performs high priority retrospective reviews of the complete medical record and the coding summary of assigned population. * Analyzes documented and clinically supported conditions in multiple electronic health record technologies to ensure complete documentation. * Performs independent coding of the record to assure that the HIM coding accurately reflects the documentation. * Ensures documented conditions, clarifications, and coded diagnoses are clinically supported. * As appropriate, enters or revises Working and Target DRGs that accurately reflect expected CDI query impact. * Demonstrates knowledge of Official Coding Guidelines and the DRG Classification System to insure regulatory compliance related to the CDI and coding functions. * Identifies and documents education opportunities for CDI Specialists * Thoroughly documents reviews and other pertinent information in designated systems by established deadlines. * Achieves and maintains key operating metrics consistent with CDI Reconciliation program requirements. HSC Escalation: * Using critical thinking skills, independent discretion, clinical judgement, Official Coding Guidelines, DRG Classification, and Coding Clinics determines when and/or if escalation to the HSC is necessary. * Escalates DRG mismatches with coding opportunities as appropriate per established protocols. * Monitors and documents HSC responses. Strategic Relationships: * Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients * Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships * Delivers information in a clear, concise and compelling manner to facilitate accomplishment of work goals * Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience * Demonstrates a willingness and ability to assist others Self-Development: * Demonstrates proficiency in current and emerging technologies * Simultaneously uses multiple technologies to complete unique patient-level reviews * Independently takes proactive steps toward problem resolution * Completes all mandatory and assigned education by established deadlines * Attends scheduled meetings and continuing education programs Education & Experience: * Bachelors degree required * 5+ years of experience in acute inpatient CDI or equivalent combination of education and/or experience required Licenses, Certifications, & Training: * Registered Nurse - Currently licensed as a Registered Professional Nurse in the state of residence * Or any coding credential nationally recognized as administered through AHIMA or ACDIS required HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleledresources and opportunitiesto reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education andcareer advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Director Case Management opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

****This is a fully remote role, but you must live within 60 miles of an HCA facility**** **Introduction** Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CDI Reconciliation Specialist like you to be a part of our team. **Job Summary and Qualifications** **Assessment of Documentation:** + Performs high priority retrospective reviews of the complete medical record and the coding summary of assigned population. + Analyzes documented and clinically supported conditions in multiple electronic health record technologies to ensure complete documentation. + Performs independent coding of the record to assure that the HIM coding accurately reflects the documentation. + Ensures documented conditions, clarifications, and coded diagnoses are clinically supported. + As appropriate, enters or revises Working and Target DRGs that accurately reflect expected CDI query impact. + Demonstrates knowledge of Official Coding Guidelines and the DRG Classification System to insure regulatory compliance related to the CDI and coding functions. + Identifies and documents education opportunities for CDI Specialists + Thoroughly documents reviews and other pertinent information in designated systems by established deadlines. + Achieves and maintains key operating metrics consistent with CDI Reconciliation program requirements. **HSC Escalation:** + Using critical thinking skills, independent discretion, clinical judgement, Official Coding Guidelines, DRG Classification, and Coding Clinics determines when and/or if escalation to the HSC is necessary. + Escalates DRG mismatches with coding opportunities as appropriate per established protocols. + Monitors and documents HSC responses. **Strategic Relationships:** + Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients + Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships + Delivers information in a clear, concise and compelling manner to facilitate accomplishment of work goals + Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience + Demonstrates a willingness and ability to assist others **Self-Development:** + Demonstrates proficiency in current and emerging technologies + Simultaneously uses multiple technologies to complete unique patient-level reviews + Independently takes proactive steps toward problem resolution + Completes all mandatory and assigned education by established deadlines + Attends scheduled meetings and continuing education programs **Education & Experience:** + Bachelor's degree required + 5+ years of experience in acute inpatient CDI or equivalent combination of education and/or experience required **Licenses, Certifications, & Training:** + Registered Nurse - Currently licensed as a Registered Professional Nurse in the state of residence + Or any coding credential nationally recognized as administered through AHIMA or ACDIS required + (CDIP) Certified Documentation Improvement Practitioner, or (RN) Registered Nurse, or (COC) Certified Outpatient Coder, or (CCS) Certified Coding Specialist, or (CPC) Certified Professional Coder, or (RHIA) Registered Health Information Administrator, or (RHIT) Registered Health Information Technician, or (ACDIS-CCDS) Certified Clinical Documentation Specialist HCA Healthcare (Corporate) (************************************************** , based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled **resources and opportunities** to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and **career advancement opportunities** , every person has a solid foundation for success. Nashville is also home to our **Executive Development Program** , where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our CDI Reconciliation Specialist opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

****This is a fully remote role but you must live within 60 miles of an HCA facility**** Introduction Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CDI Recon Specialist like you to be a part of our team. **Job Summary and Qualifications** _Assessment of Documentation:_ + Performs high priority retrospective reviews of the complete medical record and the coding summary of assigned population. + Analyzes documented and clinically supported conditions in multiple electronic health record technologies to ensure complete documentation. + Performs independent coding of the record to assure that the HIM coding accurately reflects the documentation. + Ensures documented conditions, clarifications, and coded diagnoses are clinically supported. + As appropriate, enters or revises Working and Target DRGs that accurately reflect expected CDI query impact. + Demonstrates knowledge of Official Coding Guidelines and the DRG Classification System to insure regulatory compliance related to the CDI and coding functions. + Identifies and documents education opportunities for CDI Specialists + Thoroughly documents reviews and other pertinent information in designated systems by established deadlines. + Achieves and maintains key operating metrics consistent with CDI Reconciliation program requirements. _HSC Escalation:_ + Using critical thinking skills, independent discretion, clinical judgement, Official Coding Guidelines, DRG Classification, and Coding Clinics determines when and/or if escalation to the HSC is necessary. + Escalates DRG mismatches with coding opportunities as appropriate per established protocols. + Monitors and documents HSC responses. _Strategic Relationships:_ + Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients + Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships + Delivers information in a clear, concise and compelling manner to facilitate accomplishment of work goals + Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience + Demonstrates a willingness and ability to assist others _Self-Development:_ + Demonstrates proficiency in current and emerging technologies + Simultaneously uses multiple technologies to complete unique patient-level reviews + Independently takes proactive steps toward problem resolution + Completes all mandatory and assigned education by established deadlines + Attends scheduled meetings and continuing education programs Education & Experience: + Bachelor's degree required + 5+ years of experience in acute inpatient CDI or equivalent combination of education and/or experience required Licenses, Certifications, & Training: + Registered Nurse - Currently licensed as a Registered Professional Nurse in the state of residence + Or any coding credential nationally recognized as administered through AHIMA or ACDIS required HCA Healthcare (Corporate) (************************************************** , based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled **resources and opportunities** to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and **career advancement opportunities** , every person has a solid foundation for success. Nashville is also home to our **Executive Development Program** , where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Director Case Management opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Pharmacy Resolution Specialist receives and responds to calls from members, provider/physician's offices, and pharmacies. This role makes outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests Offers options including submission of a prior authorization request Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards Logs, tracks, resolves, and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and Centene Corporate guidelines in which special care is required to enhance Centene relationships, while meeting and exceeding all performance standards Maintains expert knowledge on all pharmacy benefits and formularies, including CMS regulations as they pertain to this position Responsible for knowing and interpreting pharmacy and medical benefits Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates) Actively involved in the initiation and providing status for prior authorization/coverage determination, appeal / redetermination phone calls Responsible for ensuring outstanding attention to detail Identify root cause issues to ensure enterprise solutions and communicate findings as needed to ensure first call resolution Assists with special projects as assigned Performs other duties as assigned Complies with all policies and standards Education/Experience: High School Diploma / GED and 1 year of Job Specific call center/customer service.Pay Range: $15.87 - $27.25 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / 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.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / 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.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / 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.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). Essential Job Duties * Enters denials and requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances. * Elevates appropriate appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. Required Qualifications * At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. * Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / 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.

Provides entry level support for claims activities including reviewing and resolving member and 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 Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.