- Mount Sinai Health System (New York, NY)
- …in the department as per protocol + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements first step of ... information in Allscripts + Meets time frame for reviews / appeals as specified by Insurance / State & Federal regulation. + Enters concurrent review information… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** Job Description 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… 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
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Stony Brook University (Stony Brook, NY)
- …+ Perform minor joint procedures. + Work with clinic staff together for insurance appeals and pre-authorizations as necessary. + Coordination with clinic staff ... of patient care for both outpatients and inpatients related to rheumatologic care, including national and international referrals. + Perform consents, including for genetic testing. + Cover physicians during their absence as necessary. + Perform other duties… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...education/experience Five years minimum of managed care experience in insurance claims or contracts Four to Five years of… more
- Humana (Albany, NY)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more
- CDPHP (Albany, NY)
- …in a fast-paced high volume call center preferred. + A background in health insurance claims and appeals processing is preferred. + Experience with a ... and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people,… more
- Humana (Albany, NY)
- …+ Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. ... paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 10-31-2025 **About us**… more
- Highmark Health (Albany, NY)
- …could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of… more