Grievance & Appeals Specialist - New York, NY

We are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.The Appeals Specialist level II performs research, investigation, · and analysis of appeals, · grievances, ...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility ...

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. · Responsible for case development and resolution o ...

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. · ...

The Billing Appeals Specialist will represent the accounting department and work as a key member of the appeals team while providing full-service support to attorneys on all appeal questions. ...

The primary function of the Appeals Specialist is to support the Utilization Review (UR) Appeals process within the Department of Patient Accounts by providing follow-up and administrative assistance.Responsibilities · Provides administrative support for the Utilization Review (U ...

Law firm seeks an experienced E-Billing Specialist to join growing Accounting team. · The specialist will retrieve invoice backups from e-billing platforms, review deductions and appeal strategies. · ...

We combine psychotropic medications with evidence-based dietary supplements,nutraceuticals,and lifestyle adjustments to enhance overall well-being.Collaboration with other medical professionals is a cornerstone of our practice to ensure comprehensive care for patients. · Investig ...

This is a full-time remote role for a Digital Marketing Specialist. The Digital Marketing Specialist will be responsible for developing and executing online marketing strategies and campaigns to enhance brand visibility and engagement. · Managing social media platforms · Analyzin ...

The Workers Compensation Specialist plays a crucial role in ensuring that patients receive comprehensive and coordinated care throughout their healthcare journey. · ...

The Clinical Review Specialist (RN) conducts clinical reviews of inpatient medical appeals for medical necessity and quality of care. · Review appeal cases for medical necessity. · Analyze medical records. · Prepare summaries and rationale. · ...

We are looking for an Executive Administrative Assistant to directly support our C-Level Executives and operations. · ...

To provide clinical information to Managed Care/Insurance Companies/BHO to demonstrate medical necessity and ensure reimbursement. · Responsible for all aspects of the concurrent review program, insurance certification, and authorization process. · Develops rapport with and daily ...

The Senior Billing Specialist will be responsible for end-to-end billing and reimbursement for personal exoskeletons and physical therapy practices. · This includes benefits verification, claims submission, denial management, · appeals, payer enrollment and follow-up.4 weeks PTO ...

+ Provide clinical information to Managed Care/Insurance Companies/BHO for reimbursement; responsible for concurrent review program, insurance certification, authorization process in Psychiatric or Chemical Dependency Inpatient Units + Develops rapport with admitting clinicians f ...

We are seeking a talented Accounts Receivable Representative to join our team at New York-Presbyterian Hospital.As an Accounts Receivable Specialist in our Central Billing Office, you will play an active role in world-class care and caring. · Comprehensive and competitive benefit ...

This is a full-time remote role for a Digital Marketing Specialist. The responsible will be developing and executing online marketing strategies and campaigns to enhance brand visibility and engagement. · Expertise in Digital Marketing, Online Marketing, and Social Media Marketin ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

We represent parents in pursuing appropriate education programs and services under the Individuals with Disabilities Education Act.The Associate Attorney will be responsible for independently managing a diverse caseload of special education matters. · ...

+Join the patient-inspired team at New York-Presbyterian and bring new meaning to your career. · +Thrive as a valued member of the team and feel the pride of mission-driven achievement. · +Enjoy comprehensive and competitive benefits that support you and your family in every aspe ...