- Unknown (New York, NY)
- …management eligibility and enrollment services medicaid and chip administration health insurance appeals technology customer experience and digital solutions ... & Professional Services Government Specialties government program operations health insurance exchanges case management customer contact centers business process… more
- Unknown (New York, NY)
- …Enterprise Specialties aca compliance employee benefits administration aca reporting marketplace appeals aca irs efiling hcm optimization data integration and open ... of entities, including system integrators, HCM providers, benefit administrators, insurance brokers, direct-to-employer channels, and insurance carriers. Key… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of medical… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- CenterWell (Albany, NY)
- …data analytics, denial and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face, further/support quality related ... development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to interpret and… more
- Humana (Albany, NY)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- Elevance Health (East Syracuse, NY)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
- Cardinal Health (Albany, NY)
- …maintain optimal account receivables performance and client satisfaction. + Resolves complex insurance claims, including appeals and denials, to ensure timely ... as a subject matter expert in claims processing. + Processes claims: investigates insurance claims; properly resolves by follow-up & disposition. + Lead and manage… more
