- Humana (Albany, NY)
- …degree + Previous inbound call center or related customer service experience + Grievance and appeals experience + Prior experience interpreting Member Benefits ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- Humana (Albany, NY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- CUNY (Brooklyn, NY)
- …assessment, BIT/student support case management, freedom of expression oversight, and grievance and appeals resolution. + Collaborate with various departments ... student conduct reports; coordinating the student conduct process, grievances, and appeals . + Oversee the Faculty Student Disciplinary Committee to ensure compliance… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Level III (in addition to Level II Accountabilities) + Assists supervisor with control and monitoring of inventory levels of assigned department (including but not limited to authorizations, claims, care management referrals) according to established… more
- Humana (Albany, NY)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
- Molina Healthcare (Yonkers, NY)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Independent Health (Buffalo, NY)
- …ICD-9-CM, ICD-10-CM and HCPCS coding preferred. + Experience in compliance regulations, appeals and grievance knowledge preferred. + Ability to effectively ... (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed; effectively resolve written inquiries from customers regarding claims,… more
- City of New York (New York, NY)
- …issues that may arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance process. Serve as Hearing ... Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office...position in these proceedings. Negotiate settlements in connection with grievance disputes and collective bargaining activities. - Liaise with… more
- Molina Healthcare (Syracuse, NY)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care… more
- New York State Civil Service (Albany, NY)
- …Section 75 of the Civil Service Law.*Oversee the agency's employee grievance program, ensuring proper processing consistent with bargaining unit agreements. Assist ... to the HR Director,Agency Executives, on investigations, disciplinary and grievance matters, and assist with special projects as needed.*Develop, draft,… more