Job Title Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record
Claims Support Specialist Provides 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
Medical Coding Dispute Investigator Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals, and ensures that claims adhere to correct billing standards and regulations. Essential Job Duties Reviews coding-related
Job Title Provides subject matter expertise in the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations. Owns the product vision, backlog, and delivery outcomes and