- Molina Healthcare (Buffalo, NY)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
- Molina Healthcare (Yonkers, NY)
- …requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with federal and state ... trends and prepares reports that identify root causes for Appeals, Grievances , and Provider Disputes. Recommends and implements process improvements to achieve… more
- Molina Healthcare (Yonkers, NY)
- …that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + ... Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina… more
- Molina Healthcare (Rochester, NY)
- …Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the ... standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for… more
- Humana (Albany, NY)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Molina Healthcare (Albany, NY)
- …must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You surface systemic issues, ... Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic defects. 3. Capabilities… more
- Rochester Presbyterian Home (Rochester, NY)
- …that arise, such as mistakes, costly waste of supplies, misuse of equipment, settling grievances , etc. in a win-win manner, if possible. + Must possess the ability ... are completed within 5 days of occurrence. + Document, investigate and resolve grievances /complaints. + Maintain grievances /complaint log to track issues and… 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 ... resolution of workplace issues presented by labor leaders, and investigate union grievances or complaints. - Provide support to senior attorneys responsible for… more
- City of New York (New York, NY)
- …and various labor unions. - Conduct Step two conferences on grievances and disciplinary matters of non-uniformed employees. - Evaluate disciplinary matters ... and Hearings. - Investigate and research labor related matters, grievances and related issues. - Respond to union ...grievances and related issues. - Respond to union grievances including health and safety matters. - Handle workplace… more
- MTA (New York, NY)
- …NYCT's progressive discipline policy, as well as processes contract interpretation grievances and assists in the consistent implementation of collective bargaining ... cases; and provides recommendations to senior management in response to grievances and contract provisions. Responsibilities: + Advocate for assigned operating… more
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