- Mount Sinai Health System (New York, NY)
- …(Industry-Specific)** : + Healthcare: Experience with utilization management for medical services, procedures, or medications + Insurance : Understanding ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...management program. This role ensures the appropriate use of medical resources, compliance with regulatory standards, and coordination of… 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 (Buffalo, NY)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more
- CDPHP (Latham, NY)
- …+ Demonstrated ability to determine, analyze and solve problems related to benefits, claims appeals , claims pricing/processing by utilizing all applicable ... will address and resolve service-related issues including claim adjustment requests, appeals and complaints, eligibility determination and other claims related… more
- Humana (Albany, NY)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- MetLife (Oriskany, NY)
- …meeting all key performance indicators * Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and ... fast-paced environment and in accordance with state and department of insurance regulations. * Develop actions plans and identify return to work potential * Provides… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in ... employee development and promotional opportunities. All Levels + LPN, Medical Assistant, Health Plan customer service or claims...a minimum of one year experience working in an insurance company or medical care setting required.… more
- CenterWell (Albany, NY)
- …help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims . The Medical Director, Primary Care ... an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims . The Medical Director work… more
- Rochester Regional Health (Rochester, NY)
- … Claims and Appeals Processing: Submits and follows up on insurance claims ; resolves denials and rejections; prepares appeal letters with proper ... Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied … more
- Mount Sinai Health System (New York, NY)
- …will be onsite. **Qualifications** + Associates Degree preferred + 5 years experience in medical billing or health claims , with experience in IDX billing systems ... Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and...in a health care or insurance environment, and strong familiarity with ICD/CPT coding +… more