• Appeals Manager

    BronxCare Health System (Bronx, NY)
    …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff , the Appeal ... Overview The Appeals Manager is responsible to assist in the...patterns and trends to prepare education programs for the staff on identified deficiencies to best respond to all… more
    BronxCare Health System (11/15/25)
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  • Director Pre Appeals Management-HSO…

    Mount Sinai Health System (New York, NY)
    …the pre appeals department and related vendors , including supervision of pre appeals nurses, and support staff . + Develop and implement pre appeals ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...while controlling costs. The Director collaborates closely with medical staff , vendors, case management, and payers to secure payment… more
    Mount Sinai Health System (11/01/25)
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  • Appeals Nurse

    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...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more
    Evolent (12/24/25)
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  • Assistant General Counsel III - Appeals…

    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
    MTA (01/08/26)
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  • Medical Director - Pharmacy Appeals

    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 ... and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in accordance… more
    Humana (12/03/25)
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  • Audit & Reimbursement II- Appeals

    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
    Elevance Health (01/08/26)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …palliative care, end-of-life-care and hospice. + Apply knowledge of Health Insurance and Managed Care Programs, along with values- based care, pay-for-performance ... Support education to minimize clinical variability throughout the medical staff . + Assist case managers with Medicare and Medicaid.... + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as… more
    Mohawk Valley Health System (01/06/26)
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  • Dental Insurance Analyst

    NYU Rory Meyers College of Nursing (New York, NY)
    …posted and expected reimbursement for Article 28, Managed Care, Commercial Insurance and other payers. Analyze, audit and recover outstanding receivables. Identify ... the revenue cycle processes. Directly manage and resolve all assigned underpayment appeals , follow-up and payer relationships. Report to management any gross payment… more
    NYU Rory Meyers College of Nursing (01/07/26)
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  • Senior Counsel - Remote Opportunity

    GuideOne Insurance (New York, NY)
    …of legal professionals, including Litigation Counsel, outside counsel, and legal support staff . The role requires mastery of drafting and filing motions and ... depositions. + Prepares and drafts pre-trial motions. + Files or defends motion appeals . + Tries lawsuits. + Prepares and drafts post-trial motions. + Manages legal… more
    GuideOne Insurance (12/19/25)
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  • Director Compliance and Governance Counsel

    The Research Foundation for SUNY (Albany, NY)
    …the staff responsible for conflict management, policy administration, ethics, insurance management, and the related learning and development programs. + Monitor ... of the corporate security clearance program. The incumbent serves as the corporate FOIL Appeals Officer responsible for the timely processing of any FOIL appeals … more
    The Research Foundation for SUNY (12/02/25)
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