Jobs
>
New York City

    Appeals Coordinator - New York, United States - MagnaCare

    MagnaCare
    MagnaCare New York, United States

    3 weeks ago

    Default job background
    Description

    About The Role

    Brighton Health Plan Solutions (BHPS) is seeking an experienced Appeals Coordinator skilled in investigating and resolving grievances, provider payment disputes and medical appeals submitted by our members and providers. Responsible for ensuring all determination responses are compliant with all established regulations.

    This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

    Primary Responsibilities

    • Thorough review of claims and medical documentation.
    • Prepare cases for clinical review.
    • Advanced claim processing including professional, facility and ancillary claims.
    • Provide accurate and timely responses to appeals, grievances and all other correspondence.
    • Communicate effectively with individuals/teams to ensure high quality and timely expedition of customer requests.
    • Research and document pertinent information on claims requiring adjudication.
    • Assist Customer Service in responding to and resolving customer questions and concerns related to correspondence.
    • Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity.
    • Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking.
    • Maintain broad knowledge of client products and services.

    Essential Qualifications

    • Strong knowledge of contracts, medical terminology, and appeals processing and procedures.
    • Familiarity with computerized medical billing or claims adjudication systems.
    • Previous experience handling appeals and grievances.
    • Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
    • Ability to meet expected production standards.
    • Proficient in Microsoft Office Suite- specifically Microsoft Word and Microsoft Excel.
    • Ability to maintain a professional demeanor under pressure.
    • Capable of managing multiple complex issues.
    • Strong knowledge of contracts, medical terminology, and appeals processing and procedures.
    • High School Diploma or GED diploma; some college or business school education is a plus.

    About

    At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, youll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, youll be encouraged to bring your authentic self to work with all of your unique abilities.

    Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing todays healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning todays challenges into tomorrows solutions.

    Come be a part of the Brightest Ideas in Healthcare.

    Company Mission

    Transform the health plan experience how health care is accessed and delivered by bringing outstanding products and services to our partners.

    Company Vision

    Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

    DEI Purpose Statement

    At BHPS, we encourage all team members to bringyourauthentic selves to work with all ofyourunique abilities. Werespect how you experience the world andwelcome you to bringthe fullness ofyourlived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

    *We are an Equal Opportunity Employer

    Annual Salary Range: $45,000 - $60,000

    The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.

  • MagnaCare

    Appeals Coordinator

    3 weeks ago

    MagnaCare New York, United States

    About The Role · Brighton Health Plan Solutions (BHPS) is seeking an experienced Appeals Coordinator skilled in investigating and resolving grievances, provider payment disputes and medical appeals submitted by our members and providers. Responsible for ensuring all determinatio ...

  • MagnaCare

    Appeals Coordinator

    4 weeks ago

    MagnaCare New York, United States

    About The Role · Brighton Health Plan Solutions (BHPS) is seeking an experienced Appeals Coordinator skilled in investigating and resolving grievances, provider payment disputes and medical appeals submitted by our members and providers. Responsible for ensuring all determination ...

  • Centers Plan for Healthy Living

    Grievance and Appeals Coordinator

    5 days ago

    Centers Plan for Healthy Living Staten Island, United States

    Grievance and Appeals Coordinator · 75 Vanderbilt Ave, Staten Island, NY 10304, USA · Req #660 · Friday, May 3, 2024 · Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, a ...

  • Centers Plan for Healthy Living

    Grievance and Appeals Coordinator

    5 days ago

    Centers Plan for Healthy Living Staten Island, United States

    Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Friday, May 3, 2024Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general ...

  • Centers Plan for Healthy Living

    Grievance and Appeals Coordinator

    5 days ago

    Centers Plan for Healthy Living Staten Island, United States

    Grievance and Appeals Coordinator · 75 Vanderbilt Ave, Staten Island, NY 10304, USA · Req #660 · Friday, May 3, 2024 · Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, ...

  • OMG Technology

    Appeals Specialist

    3 weeks ago

    OMG Technology New York, United States

    **Appeals Specialist - I (Remote - EST or PST)** · The schedule will be **Monday to Friday 8 am-5 pm** local time**.** · **Position Summary**: · Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and providers (or author ...

  • VNS Health

    Grievance and Appeals Specialist, Clinical-2

    2 weeks ago

    VNS Health New York, United States Full time

    Overview · Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. ...

  • MJHS

    A&g Specialist

    3 weeks ago

    MJHS New York, United States

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-qualit ...

  • The Legal Aid Society

    Litigation Assistant

    2 weeks ago

    The Legal Aid Society New York, United States

    The Legal Aid Society, the nation's oldest and largest social justice legal services organization, has immediate openings for dedicated, passionate Litigation Assistants in the Criminal Defense Practice throughout the city as part of a newly organized Paralegal Services Unit. The ...

  • Mount Sinai

    Procedural Billing Specialist Ii

    2 weeks ago

    Mount Sinai New York, United States

    **Description** · Responsible for multiple components of the billing process for specialized or complex pre and post-surgical procedures, including coding, Accounts Receivable, Charge Entry, Edits and Payment Posting. Facilitates claims processing for services rendered by physici ...

  • Counsel Press Inc.

    Appellate Paralegal

    1 week ago

    Counsel Press Inc. New York, United States

    **Counsel Press' New York, NY location **is searching for a full time paralegal to join a seasoned team in the preparation of our client's appellate filings. Our New York location is a fast paced environment with a solid team. We offer extensive training to ensure your long term ...

  • AION Management LLC

    Leasing Associate

    1 week ago

    AION Management LLC Newark, United States

    Essential Duties and Responsibilities: · Sales/Marketing · - Conduct all leasing activities at the property, responding to telephone inquiries, providing tours of apartments and amenities, following up with prospects, and coordinating all move-ins · - Perform telephone market sur ...

  • TechIntelli Solutions, Inc.

    Medical Receptionist

    2 weeks ago

    TechIntelli Solutions, Inc. New York, United States

    **key responsibilities** · B. **Appointment Scheduling**: Coordinate client appointments, and consultations with medical staff, optimizing scheduling to accommodate client preferences and medical staff availability. Maintain an organized appointment calendar and effectively commu ...

  • Northwell Health

    Associate Patient Account Representative

    3 weeks ago

    Northwell Health New York, United States

    Performs billing, collections, third party reimbursements, computer data entry and retrieval. Helps in posting charges to accounts. · Job Responsibility · - Performs charge and payment entry; also performs coding and ensures accurate completion of coding for all assigned physicia ...

  • The Bridge Inc.

    Billing Specialist

    2 weeks ago

    The Bridge Inc. New York, United States

    The Bridge's mission is to change lives, by offering help, hope, and opportunity to the most vulnerable in our community. We offer a comprehensive range of evidence-based rehabilitative services, including mental health and substance abuse treatment, housing, vocational training ...

  • Savory Hospitality

    Creative Coordinator

    1 week ago

    Savory Hospitality New York, United States

    **About Savory** · Savory is a full-service, boutique hospitality firm on a mission to elevate the corporate dining experience, making it fresher and more reliable with a focus on quality food experiences and hospitality excellence. · At Savory, we have a common thread that reson ...

  • NYU Langone Health

    Business Office Associate

    1 week ago

    NYU Langone Health New York, United States

    Responsible for insurance review and clearance for patients of the Fink Children's Ambulatory Care Center as well as working to secure authorizations for patients coming to Fink as well as patients requiring medication prior authorizations for all specialties. Additionally, the B ...

  • Audible

    Fraud Operations Manager, Business Assurance

    3 weeks ago

    Audible Newark, United States

    At Audible, we believe stories have the power to transform lives. It's why we work with some of the world's leading creators to produce and share audio storytelling with our millions of global listeners. We are dreamers and inventors who come from a wide range of backgrounds and ...

  • Joe Coffee

    Marketing Associate

    2 weeks ago

    Joe Coffee New York, United States

    Assist the Joe Coffee team in their daily activities and offer cross-channel marketing support across retail cafes, ecommerce, and wholesale channels. · - Develop and prepare marketing support tools, briefs, and decks for sharing across various departments. · - Create impactful c ...

  • Police Athletic League Inc

    Communications Manager

    1 week ago

    Police Athletic League Inc New York, United States

    **Who we are**:The Police Athletic League (PAL) of New York City is an independent youth development nonprofit organization and has been a vibrant and vital institution, serving as an effective, critical bridge between police and communities across all five boroughs of the City s ...