- Molina Healthcare (Yonkers, 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
- Humana (Albany, NY)
- …part of our caring community and help us put health first** The Grievances & Appeals Representative 4 Investigates and resolves member and practitioner issues. ... a grievance, appeal or further request is warranted. The Grievances & Appeals Representative 4 + Review documents +...business needs. Voluntary overtime may also be available. + Grievances & Appeals (G&A) has an impact to our… more
- Molina Healthcare (NY)
- …Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist. + Generates ... and mails denial letters. + Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. + Creates and/or maintains statistics and reporting. + Works with provider & member services to resolve balance bill issues… more
- Evolent (Albany, NY)
- …We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health… more
- Humana (Albany, NY)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… 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
- 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
- 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
- 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