**JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Provider No Surprises Act cases in accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of Provider No Surprises Act cases to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the department. + Apply contract language, benefits, and review of covered services + Responsible for contacting the member/provider through written and verbal communication. + Prepares Provider No Surprises Act correspondence and document findings. Include information on trends if requested. + Composes all correspondence and Provider No Surprises Act information concisely and accurately, in accordance with regulatory requirements. **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** High School Diploma or equivalency **REQUIRED EXPERIENCE:** + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for Provider No Surprises Act cases + Strong verbal and written communication skills **PREFERRED EXPERIENCE:** + No Surprise Act Provider Disputes knowledge/experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.