Role Description Provides support for member waiver coordination activities. Contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum, and overarching strategy to provide quality and cost-effective member care. - Provides non-clinical operational support for member waiver coordination processes. - Facilitates communication between waiver coordination and the state program support unit. - Receives initial state referrals for waiver services and works with long-term services and supports (LTSS) to schedule initial assessment. - Monitors status of initial member assessments, reassessments and transition assessments. - Interfaces with state agency that determines eligibility for LTSS, to process and obtain approval of waiver services. - Monitors transition process of nursing facility members in custodial beds to return to the community. - Initiates referrals for Medicare and waiver process if member is not already Medicare or waiver established. - Tracks referrals and case documents via designated state systems. - Tracks activities occurring within the transitional, assessment and authorization processes - using internal systems and designated state systems, and reports results to accordingly. - Ensures Medicaid and waiver eligibility has been requested and received from state partners before transition/services are initiated. - Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA). - Attends internal meetings and regularly scheduled calls as assigned. Qualifications - At least 1 year of experience in an administrative support role in a health care setting, or equivalent combination of relevant education and experience. - Ability to manage multiple work tasks and prioritize. - Excellent problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Requirements - Certified Medical Assistant (CMA). - Long-term care and/or managed care experience. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description In this role, you’ll leverage your expertise in claims adjudication, contract interpretation, and risk management to guide clients, overcome obstacles, and ensure fair, compliant decisions. You’ll collaborate with internal teams and the Law Division, communicate clearly and professionally with claimants and stakeholders, and manage multiple priorities with accuracy and attention to detail. This role also offers the opportunity to mentor and support staff while continuously improving processes and efficiency. Qualifications - Prefer at least 8 years of direct Group Disability industry experience. - Thorough understanding of claims adjudication, benefit determination, investigation, file development, legal requirements, and contract interpretation. - Ability to conduct focused and extensive claims research. - Demonstrated high-level risk management, analytical, mathematical, problem-solving, and decision-making skills. - Strong persuasion, negotiation, and ability to interpret and communicate disability contract language. - Excellent communication skills with the ability to remain professional and pleasant in interactions. - Capable of conducting small group presentations and collaborating with the Law Division. - Ability to de-escalate situations on a regular basis and manage multiple priorities effectively. - Superior attention to detail, flexibility, and the ability to work independently or as part of a team. - Promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously. - Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico. Requirements - Reviews and evaluates all pre- and post-adverse benefit determination materials for Group STD, LTD, Life, AD&D, Waiver of Premium, CI and Accident appeals. - Overcomes objections through effective appeal arguments, escalates appropriately, and requests additional information as needed to clarify issues. - Renders appeal decisions using medical, vocational and legal risk management resources. - Serves as a technical expert to guide client appeal activities and leverages contract language to support sound determinations. - Prepares clear, professional written communications to claimants, representatives, policyholders, brokers and attorneys. - Documents actions thoroughly and maintains accurate records of appeal cause, disposition and trending. - Ensures compliance with ERISA and applicable federal and state laws. - Researches and evaluates emerging case law and regulatory changes, presents cases in forums, and remains current on company, industry and legislative updates. - Drives continuous improvement by identifying technological and process enhancements. - Mentors and trains staff and clients on appeals and risk management. - Contributes to internal policy development and partners with operations to ensure alignment on key processes. Benefits - Estimated Salary: - Appeals Specialist: $54,000 - $66,000 plus annual bonus opportunity. - Sr Appeals Specialist: $68,000 - $90,000 plus annual bonus opportunity. - 401(k) plan with a 2% company contribution and 6% company match. - Work-life balance with vacation, personal time and paid holidays.

Role Description This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. Position Highlights: - Full-Time Mon-Fri - Comfortable working in a high-volume production environment. - Documenting information in multiple platforms using two computer monitors. - Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and tuition Assistance You will: - Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. - Maintain confidentiality and security with all privileged information. - Maintain working knowledge of Company and facility software. - Adhere to the Company's and Customer facilities Code of Conduct and policies. - Inform manager of work, site difficulties, and/or fluctuating volumes. - Assist with additional work duties or responsibilities as evident or required. - Consistent application of medical privacy regulations to guard against unauthorized disclosure. - Responsible for managing patient health records. - Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. - Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. - Ensures medical records are assembled in standard order and are accurate and complete. - Creates digital images of paperwork to be stored in the electronic medical record. - Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. - Answering of inbound/outbound calls. - May assist with patient walk-ins. - May assist with administrative duties such as handling faxes, opening mail, and data entry. - Must meet productivity expectations as outlined at specific site. - May schedule pick-ups. - Other duties as assigned. Qualifications - High School Diploma or GED. - Ability to commute between locations as needed. - Able to work overtime during peak seasons when required. - Basic computer proficiency. - Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. - Professional verbal and written communication skills in the English language. - Detail and quality oriented as it relates to accurate and compliant information for medical records. - Strong data entry skills. - Must be able to work with minimum supervision responding to changing priorities and role needs. - Ability to organize and manage multiple tasks. - Able to respond to requests in a fast-paced environment. Benefits - Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and tuition Assistance. Company Description Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. We are committed to building a diverse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

Role Description This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations. - Full-Time Mon-Fri - Comfortable working in a high-volume production environment. - Documenting information in multiple platforms using two computer monitors. Responsibilities - Receive and process requests for patient health information in accordance with Company and Facility policies and procedures. - Maintain confidentiality and security with all privileged information. - Maintain working knowledge of Company and facility software. - Adhere to the Company's and Customer facilities Code of Conduct and policies. - Inform manager of work, site difficulties, and/or fluctuating volumes. - Assist with additional work duties or responsibilities as evident or required. - Consistent application of medical privacy regulations to guard against unauthorized disclosure. - Responsible for managing patient health records. - Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. - Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. - Ensures medical records are assembled in standard order and are accurate and complete. - Creates digital images of paperwork to be stored in the electronic medical record. - Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately. - Answering of inbound/outbound calls. - May assist with patient walk-ins. - May assist with administrative duties such as handling faxes, opening mail, and data entry. - Must meet productivity expectations as outlined at specific site. - May schedule pick-ups. - Other duties as assigned. Qualifications - High School Diploma or GED. - Ability to commute between locations as needed. - Able to work overtime during peak seasons when required. - Basic computer proficiency. - Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis. - Professional verbal and written communication skills in the English language. - Detail and quality oriented as it relates to accurate and compliant information for medical records. - Strong data entry skills. - Must be able to work with minimum supervision responding to changing priorities and role needs. - Ability to organize and manage multiple tasks. - Able to respond to requests in a fast-paced environment. Bonus Points If - Experience in a healthcare environment. - Previous production/metric-based work experience. - In-person customer service experience. - Ability to build relationships with on-site clients and customers. - Comfortable bringing new ideas, process improvement suggestions, and feedback to internal stakeholders. Benefits - Full Benefits: PTO, Health, Vision, and Dental Insurance and 401k Savings Plan and tuition Assistance.