- VNS Health (Manhattan, NY)
- …is an exciting opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care ... Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance...processes. You will play a crucial role in overseeing staff interactions and ensuring that our members' voices are… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- R1 RCM (Salt Lake City, UT)
- …governmental contractors, third-party auditors, or other payers. You will oversee the Clinical Appeals staff , strategically manage the appeals inventory and ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …. Documents IRE responses on applicable systems. . Serves as a resource/training for appeals and grievances unit staff and as a resource for internal/external ... Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service, billing or related operations preferred. **Professional… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General - Criminal Appeals Appellate Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4787704) Assistant Attorney General - ... Criminal Appeals Appellate Salary $61,110.40 - $150,404.80 Annually Location Des...sample, and resume to Mr. Zach Hoffman, Chief of Staff , at ###@ag.iowa.gov or 1305 E. Walnut St., 2nd… more
- CVS Health (Hartford, CT)
- …Management staff . * Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency. Provide after hours and weekend coverage ... this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C ...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- New York State Civil Service (Melville, NY)
- NY HELP Yes Agency Insurance Fund, State Title Assistant Attorney 1/ Assistant Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) ... law, and case documents.* Communicate, discuss, and explain to Claims Department staff the basis for rejections of appeal requests;* Preparing and timely filing… more
- Centene Corporation (Phoenix, AZ)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all State inquires related to ... complaints, grievances and appeals . + Review and process member and provider grievances...as liaison between member, provider regulatory agencies and internal staff . Correspond with key individuals regarding grievance and appeal… more
- Elevance Health (Mason, OH)
- **Manager II Grievance/ Appeals (RN)- Claims Support** **Location** : This position will work in a hybrid model (remote and office). Ideal candidates will live within ... locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals… more
- MTA (Brooklyn, NY)
- Deputy Executive Assistant General Counsel ( Appeals ) Job ID: 8104 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: ... Nov 27, 2024 Description Job Information Deputy Executive Assistant General Counsel ( Appeals ) Open Date: 7/11/2024 Close Date: Open Until Filled Authority: TA… more
- New York State Civil Service (Albany, NY)
- …Services, Department of Title Director of Health Complaints and External Appeals (Director Financial Services Programs 3, NS) Occupational Category Other ... candidates for the position of Director of Health Complaints and External Appeals in Consumer Protection and Financial Enforcement Division (CPFED). The incumbent of… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their respective auditors. Ensures the most accurate and descriptive… more
- CVS Health (Columbus, OH)
- …oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers. As a ... cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- Community Health Systems (Fort Smith, AR)
- As a Remote Medical Denials / Appeals Specialist at Community Health Systems - Shared Services Center, you'll play a vital role in supporting our purpose to help ... serve. Our team members enjoy a robust benefits package including health insurance , flexible scheduling, 401k and student loan repayment programs. The Remote Medical… more
- State of Indiana (Indianapolis, IN)
- …analyze facts and draw logical conclusions. + Ability to work independently and with appeals supervisor and support staff . + Able to perform essential functions ... Appeals Referee Date Posted: Jan 21, 2025 Requisition...election years + Education Reimbursement Program + Group life insurance + Referral Bonus program + Employee assistance program… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as needed, coordinating ... requiring Residential Health Care Facility placement. * Assist in having appropriate staff complete discharge forms in a timely manner. * Coordinates the Discharge… more
- Harvard University (Cambridge, MA)
- …combination of remote and onsite work at our Boston, MA based campus. HBS expects all staff to be onsite a minimum of 3 days per week and departments provide onsite ... the associate director will be responsible for HBS's alumni-focused direct marketing appeals program (mail, email, web overlays) aimed primarily at boosting annual… more
- City and County of San Francisco (San Francisco, CA)
- …role in fostering innovation and improving departmental practices. + Staff Management: Key responsibilities include recruiting, training, evaluating, and recognizing ... staff . The Director addresses disciplinary actions when necessary and...Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'… more
- CAMBA (Staten Island, NY)
- Who We Are: CAMBA is a community of staff , volunteers, clients, donors, neighbors and partners who work together to build an inclusive New York City, where all ... services that allow members of our community improve their lives. Position: Staff Attorney (Housing Unit) Reports To: Program Manager Location: 56 Bay Street,… more
- Brooklyn Defender Services (Brooklyn, NY)
- …services, including for housing, public benefits, education, and employment. BDS staff work collaboratively and across disciplines to deliver high-quality legal ... frequent hearings and trials, often on an emergency basis. Staff attorneys are expected to provide high-quality and zealous...their case. + In collaboration with our law and appeals and paralegal teams, write motions, memos of law… more