Top 1213 Authorization representative Jobs in New York State

Expedited Appeals Specialist (Remote)
EmblemHealth —New York, NY
- $48,600 - $83,160 a year
- Weekends as needed
- Remote
- Microsoft Outlook
- Research
- Mid-level
Evidence & Property Control Specialist II
Agency DEPT OF HEALTH/MENTAL HYGIENE —New York, NY
- $68,620 - $95,523 a year
- Full-time
- Military
- Mid-level
- High school diploma or GED
- Loan forgiveness
Secretary II - Intake/Scheduler (FGP) - Radiology Scheduling, Manhattan
NYU Langone Health —New York, NY
- $61,692.74 - $61,692.75 a year
- Inventory management
- HIPAA
- Mid-level
- Wellness program
7d
Pre-Authorization Representative - Schuyler Hospital
Cayuga Health System —Montour Falls, NY
- $20.50 - $26.00 an hour
- Full-time
- Remote
- Anatomy knowledge
- Hospital
- Computer literacy
Quick Apply
8d
Patient Liaison
Westchester Medical Center —Valhalla, NY
- $40.17 an hour
- Per diem
- Hospital
- Adults
- Mid-level
Senior Patient Access Services Representative
Northwell Health —Lake Success, NY
- $41,780 - $64,340 a year
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
Clinical Coordinator - Patient Engagement Center
Albany Medical Center —Albany, NY
- $59,066 - $88,599 a year
- Full-time
- HIPAA
- Mid-level
- Pediatrics
Forensic Mortuary Technician I
Agency DEPT OF HEALTH/MENTAL HYGIENE —New York, NY
- $48,481 - $62,920 a year
- Full-time
- Sanitation
- High school diploma or GED
- Driving
- Loan forgiveness
Director of Early Intervention Systems, Bureau of Early Intervention
DEPT OF HEALTH/MENTAL HYGIENE —Queens, NY
- $110,067 - $125,000 a year
- Full-time
- 18 years or older
- Research
- Office
- Wellness program
- Health insurance
8d
Health Insurance Biller, Bureau of Revenue
Agency DEPT OF HEALTH/MENTAL HYGIENE —Queens, NY
- $74,079 - $78,470 a year
- Full-time
- Writing skills
- Mid-level
- Office
- Wellness program
- Health insurance
Telephone Representative II (Provider Relations)
1199SEIU Family of Funds —New York, NY
- $49,495.68 - $62,570.04 a year
- Full-time
- Research
- Mid-level
- High school diploma or GED
- Vision insurance
Nurse Coordinator (RN) - Rochester, NY
Hillside Children’s Center —Rochester, NY
- $75,000 - $90,000 a year
- Weekends as needed
- Background check
- Experience working with individuals with developmental disabilities
- Nursing
- 403(b) matching
- Health insurance
Quick Apply
Medical Billing Coordinator
Cazenovia Recovery Systems, Inc —Buffalo, NY
- $25 - $26 an hour
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
PROS Registered Nurse: 8K Sign On Bonus
JAWONIO INC —New City, NY
- $40 - $46 an hour
- Weekends as needed
- Nursing
- Management
- RN License
- Flexible schedule
Quick Apply
Construction Inspectors & Engineers (ICC, ACI, CWI, etc.)
Tectonic MSA LLC —Astoria, NY
- $20 - $55 an hour
- Construction site
- Bachelor of Science
- Mid-level
- Profit sharing
- Commuter assistance
Quick Apply
Assistant Nurse Manager - Monroe Residential Campus
Hillside Children’s Center —Rochester, NY
- $80,000 - $100,000 a year
- Weekends as needed
- Background check
- Nursing
- Clean driving record
- 403(b) matching
- Health insurance
Quick Apply
Welder
Graham Manufacturing —Batavia, NY
- $27 - $31 an hour
- Overtime
- Basic math
- Mid-level
- High school diploma or GED
Quick Apply
Bus Driver
The Arc - Jefferson & St. Lawrence —Canton, NY
- $20.53 - $23.40 an hour
- Weekends as needed
- Computer literacy
- Mid-level
- CDL
Quick Apply
Manufacturing Engineering Manager
YOUNG & FRANKLIN INC —Liverpool, NY
- $110,000 - $170,000 a year
- Management
- Office
- Master's degree
Quick Apply
1d
Manufacturing Engineer
Aero Structures Long Island, Inc. —Westbury, NY
- $90,000 - $125,000 a year
- Full-time
- AutoCAD
- 7 years
- Microsoft Excel
- Paid holidays
- Health insurance
Quick Apply

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authorization representative jobs near new york state

Expedited Appeals Specialist (Remote)

EmblemHealth -
New York, NY

Apply Now

Job Details

$48,600 - $83,160 a year

Qualifications

Appeals
Correspondence management
Microsoft Outlook
Team leadership
Coaching
Case appeal in utilization management
Team training
Mentoring
Microsoft Teams
SharePoint
Insurance claims appeal handling

Full Job Description

Summary of Position

Responsible for processing expedited appeals: those that are complex in nature, require multiple hand-offs, and tend to have extremely tight deadlines. Ensure accuracy and compliance within the constraints of extremely quick turnaround times. Perform end-to-end G&A processing; consistently operate in a fast-paced high-pressure environment. Monitor all aspects of the G&A process; ensure that members have appropriate access to care. Due to regulatory requirements and turn-around times of the Expedited Appeal unit, the Specialists are required to work weekends and holidays as the organization must maintain expedited appeal coverage 7 days a week, 365 days a year.

Principal Accountabilities

Independently perform triage function: review and evaluate appeal requests; identify and classify member and provider appeals. Using internal systems, determine eligibility, benefits, and prior activity related to the claims, payment, or service in question.
Provide verbal and written member and provider correspondence as needed for authorized representative or needed clinical information.
Conduct thorough investigations of all member and provider correspondence by analyzing all the issues presented and obtaining responses and information from internal and external entities. Validate the responses to ensure they address the issues and are supported by any contract stipulations, regulations, etc., as applicable.
Make critical decisions regarding research and investigation to appropriately resolve all inquiries; prepare cases for medical and administrative review detailing the findings of their investigation for consideration in the Plan’s determination; make recommendations on administrative decisions by preparing detailed case summaries and reviewing all applicable benefit and contract materials; present findings and recommendations to appropriate parties for sign-off.
Serve as liaison with EmblemHealth departments, delegated entities, medical groups, and network physicians to ensure timely authorization effectuation and resolution of cases.
Perform necessary follow-up with responsible departments and delegated entities to ensure compliance.
Monitor hourly and daily pending reports and personal worklists, ensuring adherence to CMS, NCQA, DOH, NYS, Connecticut and Massachusetts regulatory requirements, as well as operational SLAs and department performance standards, thereby ensuring members’ access to care.
Independently prepare well written, customized responses to all correspondence that appropriately and completely address the complainant’s issue(s) and are structurally accurate. Responsible for ensuring responses are completed within the applicable regulatory timeframe.
Complete submission of case files and responses to entities such as DFS, DOH, AG and Maximus; ensure timely and appropriate response submissions.
Document final resolutions along with all required data to facilitate accurate reporting, tracking, and trending.
Identify workflow improvements and work with the team to recommend and implement change(s).
Provide recommendations to management regarding issue resolution, root cause analysis and best practices.
Serve as a point of escalation for problems, providing guidance and expertise to team members as well as helping to identify and address core business requirements.
May train, guide, and mentor new G&A Specialists.
Serve as a coach and mentor to the associates providing support and guidance in complex situations.
Maintain acceptable attendance standard with minimal unscheduled PTO.
Exceed median production and compliance standards for both case resolution and data requirements.
Perform other duties as directed, assigned, or required.

Qualifications

Bachelors’ degree
3 – 5+ years of related experience, preferably in the health industry and/or area of compliance
Additional related experience/specialized training may be considered in lieu of degree requirements
Extensive knowledge and experience in claims, enrollment, benefits, and member contracts
Ability to mentor specialists and to provide assistance on complex cases
Must be well versed in all aspects of the complaint, grievance and appeal process and be able to process all types of correspondence handled by Grievance and Appeals
Proficiency in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.)
Excellent product knowledge
Excellent prioritizing, organizing, time management, problem solving and analytical skills
Ability to work under pressure and deliver complete, accurate, and timely results
Leadership skills

Additional Information

Requisition ID: 1000003249
Hiring Range: $48,600-$83,160

Apply Now

Refine Your Search

authorization representative jobs in new york state

Expedited Appeals Specialist (Remote)

Evidence & Property Control Specialist II

Secretary II - Intake/Scheduler (FGP) - Radiology Scheduling, Manhattan

Pre-Authorization Representative - Schuyler Hospital

Patient Liaison

Senior Patient Access Services Representative

Clinical Coordinator - Patient Engagement Center

Forensic Mortuary Technician I

Director of Early Intervention Systems, Bureau of Early Intervention

Health Insurance Biller, Bureau of Revenue

Telephone Representative II (Provider Relations)

Nurse Coordinator (RN) - Rochester, NY

Medical Billing Coordinator

PROS Registered Nurse: 8K Sign On Bonus

Construction Inspectors & Engineers (ICC, ACI, CWI, etc.)

Assistant Nurse Manager - Monroe Residential Campus

Welder

Bus Driver

Manufacturing Engineering Manager

Manufacturing Engineer

I want to receive the latest job alert for authorization representative in new york state

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