- Molina Healthcare (Albany, NY)
- …* Manages team responsible for the submission/resolution of member and provider appeals and grievances ; ensures resolutions are compliant with applicable ... call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees/monitors appeals to ensure all internal and… more
- Guardian Life (Albany, NY)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... to Dental Support Organization (DSO) partners. As a **Key DSO Dental Account Manager , Dental Support Organizations** , you will be responsible for growing the… more
- Sharecare (Albany, NY)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Molina Healthcare (Albany, NY)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- University of Rochester (Albany, NY)
- …claims. + Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. 10% Keeps management ... Receivable Management. **ESSENTIAL FUNCTIONS** With general direction of the Manager /Supervisor/Lead: 40% Follows department policies and procedures and maintains… more