- Molina Healthcare (Yonkers, NY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Molina Healthcare (Buffalo, NY)
- …assist with research. + Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Humana (Albany, NY)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and… more
- Humana (Albany, NY)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting ... and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer… more
- Molina Healthcare (Albany, NY)
- …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... 2. Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic… more
- Molina Healthcare (Rochester, NY)
- …and independent contracting, down line broker applications commissions, Broker Agent appeals / grievances , educating Brokers on plan benefits in all markets, ... Oversees the detailed process of broker commission reconciliation * Handles Broker Agent appeals / grievances . * Educates Brokers on plan benefits in all markets.… more
- Molina Healthcare (Syracuse, NY)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals / Grievances , within three months of working in position. + Demonstrates ability ... to handle complex assignments, difficult members and highly visible issues. + Understanding of the basic Utilization Management and Case Management aspects of the department + Excellent written and verbal communication skills. + Excellent computer skills and… more
- CUNY (Brooklyn, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . + Oversee the Faculty Student Disciplinary ... process, early intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization of the Behavioral… more