- Rising Medical Solutions (Milwaukee, WI)
- The Claims Specialist will assist in reviewing, processing, and coordinating claims accurately in accordance with the program requirements while ensuring ... With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers,… more
- Molina Healthcare (Milwaukee, WI)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides support ... for claims activities including reviewing and resolving member and provider...appropriate appeals and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates… more
- Molina Healthcare (Milwaukee, WI)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist . This position is remote and will be working Pacific Standard hours. Highly Qualified ... to detail + AOR/IRE understanding highly preferred Provides support for claims activities including reviewing and resolving member and provider complaints, and… more
- Molina Healthcare (Milwaukee, WI)
- …diagnosis-related group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance ... auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review, or equivalent combination of relevant… more
- Molina Healthcare (Milwaukee, WI)
- …to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of ... to present those findings. **Preferred License, Certification, Association** + AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified… more