- Molina Healthcare (Rochester, NY)
- …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… 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
- Humana (Albany, NY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… 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
- Elevance Health (New York, NY)
- …of out of network pre-authorization requests for services. + Conducts review of grievance and appeals requests to provide to Medical Directors. **Minimum ... Requirements:** + Requires MA/MS from an ARC-PA (Accreditation Review Commission for the Physician Assistant) accredited program or an ACEN/CCNE (Accreditation Commission for Education in Nursing or Commission on Collegiate Nursing Education) accredited… more
- Elevance Health (Latham, NY)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... consistent use of medical policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and… 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 (Buffalo, NY)
- …Management + Experience working with complex, often highly technical teams + Appeals & Grievance , healthcare services, or claims background **Preferred License, ... Certification, Association** Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through… more
- Molina Healthcare (Yonkers, NY)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… 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