- Cognizant (Albany, NY)
- ** Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to...or Grievance is legitimate. A strong understanding of Claims, Appeals and Medical Benefits. Referring suspicious or… more
- Molina Healthcare (Yonkers, NY)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Molina Healthcare (Buffalo, NY)
- …for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Molina Healthcare (Albany, NY)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- Mount Sinai Health System (New York, NY)
- …/ Denials when received in the department as per protocol + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + ... **Job Description** **Insurance Specialist MSH PT Days 4/Days Week (Days Vary)...Photo Copying Service, outside 2nd party and / Discharge Appeals + Maintain the integrity of the Medical… more
- FlexStaff (Chappaqua, NY)
- **Req Number** 166290 FlexStaff is seeking an Account Receivable Specialist with experience in physician medical billing for one of our clients, a medical ... in Chappaqua, NY. Qualifications: * Proven experience in physician medical billing, specifically with Medicare Part B and in-network...and appealing denied or incorrectly paid claims. * Payer Appeals : Prepare and submit payer appeals through… more
- Independent Health (Buffalo, NY)
- …reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities as well as coordination of all aspects ... fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical decisions on… more
- FlexStaff (Chappaqua, NY)
- **Req Number** 163081 FlexStaff Our client is seeking a skilled Medical Biller/Accounts Receivable Specialist with a minimum of 2 years of experience in ... medical billing, including filing claim appeals . The...supervision of a Senior Team Lead, the Accounts Receivable Specialist is responsible for superior collection efforts of outstanding… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … Medical Services division. Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of ... programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in addition to Level II… more
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