- Excellus BlueCross BlueShield (Buffalo, NY)
- …on the Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) ... + Develops, conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as needed. + Ensures… more
- University of Rochester (Albany, NY)
- …of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. + 10% Keeps management ... informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. + 5% Collaborates with Claim Edit… more
- Highmark Health (Albany, NY)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
- Molina Healthcare (Albany, NY)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Molina Healthcare (Nassau, NY)
- …remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals . * Connects members to CCEs, the OhioRISE Plan,or Molina ... Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits . * Knowledge of internal MCO processes and procedures related to Care Guide responsibilities… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... play a key role in managing internal labor relations investigations, union grievances , and collective bargaining agreements and engagement with Union Partners, and… more
- New York State Civil Service (Albany, NY)
- …and case law. The incumbent serves as the Chancellor's representative in hearing appeals of disciplinary and contract grievances pursuant to the collective ... bargaining agreements, and coordinates the defense of improper practice charges before the Public Employment Relations Board. The incumbent also represents the State-operated campuses in the expedited disciplinary arbitration process for all CSEA represented… more
- City of New York (New York, NY)
- …related to labor law and employee discipline. The unit handles employee grievances , prosecutes disciplinary cases, and works with attorneys at the Mayor's Office ... workplace issues presented by labor leaders, and investigate union grievances or complaints. - Provide support to senior attorneys...in the Rules of the New York Court of Appeals (Sections 520.3 or 520.5) or admission to the… more
- City of New York (New York, NY)
- …document sharing site. 2. Serve as key person for processing all incoming Grievances by assigning case numbers and hearing officers for all new grievances ... via Employee Service Connect. Prepare folders, update database and schedule all Grievances for Telephone Scheduling Conferences (TSC). 3. Set up and host TSCs via… more
- City of New York (New York, NY)
- …the Uniform Commercial Code ("UCC"); 10) assist division staff with procurement appeals and decision process, including draft opinions and presenting facts and ... and others on issues pertaining agency employees, locals representing employees, grievances , and any other issues that arise regarding the collective bargaining… more