- Healthfirst (NE)
- …-QOC experience preferred + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently...such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess). Experience… more
- Molina Healthcare (Grand Island, NE)
- …Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business Development teams to ... reimbursement tolerance parameters (across multiple specialties/geographies). Obtains input from Corporate , Legal and other stakeholders regarding new reimbursement models… more