General Community Support Specialist, Kittitas Interactive Management is looking for quality Care Providers. All hours available. Must be 18 years of age, have valid identification, high school graduate or GED and be able to pass a background check.
JOB SUMMARY Supervises Network Provider Services Department and Member Appeals and Grievances through delegation of duties and monitoring of daily operations, according to the department’s policies and procedures. ESSENTIAL FUNCTIONS : Direct supervision of Provider Service function, specifically Provider Services Representatives.
JOB SUMMARY : Negotiates assigned contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers.
POSITION SUMMARY Resolves Provider Reconsideration Requests (PRR) from providers relating to claims payment and requests for claim adjustments. Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Senior Web Content Manager, Service Provider (Renton, WA) Want to join one of the fastest-growing, most innovative software companies in the world? Are you interested in taking on an exciting,.
MATRIX MEDICAL NETWORK is dedicated to helping in the care of Medicare Advantage plan members. Our success comes as the result of our extraordinary people, years of experience, advanced technology and powerful information management capabilities.
POSITION SUMMARY Respond to telephone inquiries from both Molina Members and Providers and provide accurate, efficient, and courteous service. ESSENTIAL FUNCTIONS : Duties and Responsibilities Respond to incoming calls from members and providers excluding provider claims calls.
POSITION SUMMARY Responsible for the assessment, planning implementation, coordination, monitoring, and evaluation of case management services. ESSENTIAL FUNCTIONS Duties and Responsibilities Identifies, assesses and manages medically catastrophic cases per established criteria.
POSITION SUMMARY Responsible for the assessment and review, coordination and distribution of review decisions for members identified with medical, surgical, and long-term care, needs including home and community-based waiver recipients. Interacts with Medical Directors, HCS department staff, various other Molina staff and providers and practitioners to ensure timely receipt of decisions in accordance with Molina policies, procedures and processes.
POSITION SUMMARY (Briefly describe the purpose of the position): Responsible for data collection and analysis regarding specific Provider Inquiries, Disputes and/or Appeals. Develops necessary policies and procedures and oversees quality assurance measures related to Provider Disputes.
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