- Centene Corporation (New York, NY)
- …optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and ... medical necessity appeals . + Participates in provider network development and new market expansion as appropriate. + Assists in the development and implementation of… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …physicians, hospitals, and other healthcare providers with member benefits, eligibility, and appeals . The Customer Service Representatives must be able to work in ... a high-volume call center, experience with medical specialties, complaints and appeals and call center responsibilities. Previous experience in a physician's office,… more
- New York State Civil Service (Albany, NY)
- …FOIL activities; generating and distributing weekly FOIL statistics; promptly sending appeals to FOIL Appeals Officer; assisting regional FOIL Coordinators, ... as needed; monitoring voicemail and returning messages; setting up various meetings; and participating in trainings and FOIL calls. They would assist the Ethics Officer and Corporate Bureau with administrative tasks such as, filing, managing and entering… more
- WMCHealth (Valhalla, NY)
- …potential patients and processes and follows up on independent dispute resolution appeals . Responsibilities: + Reconciles billing and payment data on an automated ... account will be sent for independent dispute resolution. + Prepares and submits appeals for independent dispute resolution. + Negotiates with third party payors on… more
- FlexStaff (Chappaqua, NY)
- …via phone and online, and appealing denied or incorrectly paid claims. * Payer Appeals : Prepare and submit payer appeals through mail, phone, or online ... platforms. * Documentation: Accurately document actions taken to collect outstanding balances on patient accounts and attach relevant documents. * Follow-Up: Conduct timely follow-ups on outstanding claims, communicating with payers, patients, referring… more
- J&J Family of Companies (Smithtown, NY)
- …assigned. . Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) . Ability to establish relationships, collaborate, and influence… more
- J&J Family of Companies (New York, NY)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) + Ability to establish relationships, collaborate, and influence… more
- J&J Family of Companies (Newburgh, NY)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) + Ability to establish relationships, collaborate, and influence… more
- Highmark Health (Albany, NY)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals . The Customer Service Representatives must be able to work in ... review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities. Previous experience in a physician's… more
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