- 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
- Molina Healthcare (Albany, NY)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… 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
- New York State Civil Service (Albany, NY)
- …of their legal rights, advises them of complaint filing procedures, assist with appeals / grievances , or refers them to other government or private agencies. * ... and prepares memoranda. * Coordinates with Assistant Attorney General/ Helpline Manager to identify cases involving potential violations or systemic issues that… 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