- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS ... Registered Nurse License/Registration and BSN preferred + At least 2-3 years of clinical hospital nursing experience + Managed care/UR/CM experience strongly preferred + Knowledge of state and federal regulations that govern health insurance coverage +… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials and … more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Molina Healthcare (Yonkers, NY)
- …Manages team responsible for the submission/resolution of member and provider appeals and grievances; ensures resolutions are compliant with applicable standards and ... call tracking system of correspondence and outcomes for provider and member appeals /grievances; oversees/monitors appeals to ensure all internal and regulatory… more
- Molina Healthcare (Yonkers, NY)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm… more
- Molina Healthcare (Yonkers, NY)
- …may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream initiatives that span people, ... Design scalable workflows and controls across intake, adjudication, adjustments, appeals /grievances, and payment integrity. + Technology Enablement: Oversee requirements,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/Case Manager (Inpatient) Mount Sinai Morningside FT Days EOW** The Case Manager (CM) will be responsible for all aspects of case ... or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum...with physicians and managed care companies on concurrent denial appeals 15. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or a minimum of...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- New Jersey Institute of Technology (Newark, NJ)
- Title: Prospect Manager Department: SVP Advancement Reports To: Executive Director of Operations and Analytics Position Type: Staff Position Summary: Prospect ... Manager is responsible for overall leadership of prospect development...and deadlines. -Guide constituent list segmentation for annual giving appeals , planned giving appeals and marketing, and… more
- J&J Family of Companies (New York, NY)
- …Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be a field-based position that will include the Brooklyn, ... help overcome challenges to fulfillment, on-boarding, and adherence. The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead… more
- City of New York (New York, NY)
- …- Investigates and advises the agency concerning contract disputes, and appeals on the rejection of equipment, materials, or workmanship; compiles contract ... or encapsulation of lead contained in or on any surface. CONSTRUCTION PROJECT MANAGER - 34202 Qualifications 1. A four-year high school diploma or its educational… more
- CUNY (Bronx, NY)
- Associate Director of Compliance and Operations (Financial Aid Manager ) **POSITION DETAILS** The City University of New York (CUNY), the nation's largest public ... aspects of financial aid, from application and award to disbursements, appeals (including special circumstances, professional judgments). + Develops and implements a… more
- Citigroup (New York, NY)
- …to facilitate loan closings, including pipeline management, loan escalations / appeals and advocacy, application quality and pricing issues. + Strictly adhere ... to internal control policies such as the account opening and credit protocols of accurate collection, completion and updating of all required documentation. + Appropriately assess risk when business decisions are made, demonstrating particular consideration… more
- Molina Healthcare (Yonkers, NY)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim ... and internal appeals review activities - ensuring alignment with applicable state...Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional… more
- Mount Sinai Health System (New York, NY)
- …collection. The Specialist works directly with the Department Administrator. Reports to Billing Manager /Revenue Cycle Manager . *Please note that this is NOT a ... financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations. + Develop and manages fee… more
- Elevance Health (New York, NY)
- …and/or serve as a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations. + Obtain additional state ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of company… more
- Molina Healthcare (Yonkers, NY)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
- City of New York (New York, NY)
- …PERMANENT EMPLOYEES IN THE TITLE AND THOSE THAT ARE REACHABLE ON THE ADMINISTRATIVE MANAGER CIVIL SERVICE LIST ARE ELIGIBLE TO APPLY. The New York City Department of ... work. Job Duties and Responsibilities: - Serve as the Reasonable Accommodations Appeals Unit coordinator and processing incoming requests. - Maintain an agencywide… more
- Mount Sinai Health System (New York, NY)
- …charge entry. 6. May run and work missing charges, edits, denials list and process appeals . Posts denials in EPIC/IDX on a timely basis. 7. Posts all payments in IDX ... billing concerns. 16. Mentors less experienced Billing staff and assists Billing Manager /FPA Manager in training new staff. 17. May approve EPIC work queue for… more
- Sponsors for Educational Opportunity (SEO) (New York, NY)
- …Events & Development Operations Department: Development Report to: Senior Manager , Development Operations Compensation: $30.82 - $36.30/Hour FLSA: Non-Exempt ... implement additional donor stewardship and cultivation activities. Reporting to Senior Manager , Development Operations, the Senior Associate will also work closely… more
