Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Medicaid Appeals & Grievances Specialist

Molina Healthcare

At Molina Healthcare, the Claims Appeals Specialist provides support for handling member and provider complaints, aligning with CMS standards and regulatory requirements. The role focuses on researching and resolving appeals, disputes, and grievances with timely communications to authorized representatives. The position emphasizes navigating Medicaid/Medicare guidelines, reviewing records, and producing clear appeal summaries. #J-18808-Ljbffr Molina Healthcare

Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Medicaid Appeals & Grievances Specialist in New York, NY vacancy
  •  ...standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside... 
    Suggested
    Remote job
    Contract work
    Work at office

    Molina Healthcare

    New York, NY
    3 days ago
  •  ...A-Line Staffing Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and appeals workflow in a regulated environment. You will review, process and coordinate cases across teams to ensure timely, accurate outcomes. This hybrid role... 
    Suggested
    Work at office
    Remote work

    A-Line Staffing Solutions

    New York, NY
    2 days ago
  • Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant... 
    Suggested
    Remote job
    Work from home

    Point32Health, Inc.

    New York, NY
    1 day ago
  • A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching... 
    Suggested
    Remote work

    Healthfirst

    New York, NY
    20 hours ago
  • $26.99 per hour

    We are currently seeking experienced Appeals & Grievances Specialists!  This is a full remote opportunity paying $27/hr.  The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints.  Experience in ACA is a plus.  If... 
    Suggested
    Hourly pay
    Permanent employment
    Temporary work
    Work experience placement
    Remote work
    Shift work
    New York, NY
    10 days ago
  • Jobgether SRL in the United States is seeking an Appeals Specialist I to research and resolve member and provider appeals, disputes, and reconsiderations...  ...The role requires knowledge of healthcare claims, Medicare/Medicaid rules, and strong written and verbal communication to... 
    Remote job

    Jobgether SRL

    New York, NY
    1 day ago
  • $51k - $74.88k

     ...The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all of HFs line of businesses which include commercial Medicaid dual enrollments Medicare and complete care. Appeals Specialist is the subject matter expert responsible for non... 
    Full time
    Temporary work
    Work experience placement
    Remote work

    HF Management Services

    New York, NY
    9 days ago
  • $90.58k - $114.59k

    Position InformationNY HELPS: No55-b/c Eligible: NoAgency: Medicaid Inspector General, NYS Office of the Title: Investigative Specialist 2 MedicaidOccupational Category: No PreferenceSalary Grade: 23Bargaining Unit: PS&T - Professional, Scientific, and Technical (PEF)Salary... 
    Permanent employment
    Full time
    Work experience placement
    Internship
    Work at office
    Remote work
    Visa sponsorship

    State of New York, USA

    New York, NY
    3 days ago
  • Aspirion is seeking a Denials Appeals Specialist to analyze denial reasons, draft and submit appeals, and support improved cash flow. You will work with carriers and internal teams to resolve claims and minimize revenue leakage. Ideal candidates bring strong analytical... 
    Remote job

    Aspirion

    New York, NY
    2 days ago
  •  ...Medicaid Eligibility Verification Specialist The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty... 
    Full time
    Work at office

    New York City | Administration & Human Resources

    New York, NY
    1 day ago
  • TITLE : Entitlement Medicaid Specialist (Part-Time) REPORTS TO : Director of Entitlements LOCATION : Manor: 219 East 121st St. New York, NY 10035 OUR MISSION: Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals... 
    Temporary work
    Part time
    Work at office
    Local area
    Flexible hours

    Odyssey House Inc

    New York, NY
    1 day ago
  • Access Healthcare is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and reconcile payments for Medicare Advantage members. This role demands meticulous attention to detail, strong analytical skills, and the ability to navigate multiple systems... 

    Access Healthcare

    New York, NY
    1 day ago
  •  ...Medicaid Eligibility Specialist Applicants must be permanent in the eligibility specialist civil service title. If you are hired provisionally in this title, you must take and pass the civil service exam when it becomes available, to be eligible for continued employment... 
    Permanent employment
    Full time
    Work experience placement
    Work at office

    New York City | Jobs

    New York, NY
    1 day ago
  • City of New York is seeking six Medicaid Eligibility Specialists for the Home Care Services Program Medicaid Eligibility Unit. Responsibilities include reviewing Medicaid applications and renewals for HCSP recipients, using WMS and external systems to process actions,... 

    City of New York

    New York, NY
    5 days ago
  • Med-Metrix is seeking a Medicaid Coordinator to support hospital clients by gathering and processing Medicaid applications for in-house and discharged patients. You will screen eligibility by phone, enroll patients, verify information, and maintain PHI in HIPAA-compliant... 

    Med-Metrix

    New York, NY
    5 days ago
  • $23.56 - $25.77 per hour

     ...Medicaid Billing Clerk It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion...  .... Bill payers by inputting billing information into databases. Appeal denied claims utilizing clearinghouse or payer portal... 
    Local area

    Public Partnerships | PPL

    New York, NY
    3 days ago
  • $22.15 - $24 per hour

     ...What You Will Do - Essential Functions The Appeals Coordinator processes and documents all...  ...Labor (DOL), Centers for Medicare and Medicaid Services (CMS), Federal and State laws....  ...is responsible for assisting the Appeals Specialists with the day-to-day operations of the Appeals... 
    Hourly pay
    Work at office
    Local area
    Remote work
    Work from home
    Home office
    Flexible hours

    Us

    New York, NY
    4 days ago
  •  ...Housing Specialist The Department of Social Services (DSS) is comprised of the administrative...  ...public benefits and services including Medicaid, food stamps, and cash assistance. HASA...  ..., and SSI or SSD application and appeal. HIV/AIDS Services Administration (HASA... 
    Permanent employment
    Temporary work
    For contractors

    New York City | Social Services

    New York, NY
    4 days ago
  •  ...contract negotiations and interpretation, investigation and processing of employee grievances and hospital discipline. Conducts hearings at the Corporate level, participates in arbitration appeals and maintains liaison with employee union representatives and personnel labor... 
    Contract work
    Work at office
    Local area
    Work from home
    Shift work

    Central office

    New York, NY
    4 days ago
  • $22 per hour

    Broadway Ventures, a United States-based firm, is seeking candidates for a temporary 6-month role that is 100% remote. Compensation is $22 per hour with training provided. Responsibilities include prioritizing workload, using OnBase and MAS to record and upload documents...
    Remote job
    Hourly pay
    Temporary work

    Broadway-Ventures

    New York, NY
    4 days ago
  •  ...opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of...  ...and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members... 
    Contract work

    MJHS

    New York, NY
    15 days ago
  • $130k - $170k

     ...Bachelor’s degree or higher. New York City | On-site $130,000–$170,000 base + bonus This opportunity should particularly appeal to someone who enjoys the front end of private equity investing: identifying businesses, opening new relationships, and creating... 
    Full time

    Metric

    New York, NY
    3 days ago
  • $250k

     ...Hospitals , has an opportunity for an Employee and Labor Relations Specialist. PAGNY is one of the largest physician groups in New York...  ...conducts and documents workplace investigations, responds to grievances, and advises site leadership on discipline and contract... 
    Full time
    Contract work
    Work at office
    Local area
    Immediate start
    Flexible hours

    Physician Affiliate Group of New York, P.C. (PAGNY)

    New York, NY
    2 days ago
  •  ...complaints to determine appropriate next steps, and lead or support fact-finding activities and investigations related to employee grievances and workplace concerns. Review disciplinary actions submitted by managers before issuance to ensure accuracy, consistency, and... 
    Contract work
    Temporary work
    Work experience placement
    Monday to Friday

    Vanguard Group Staffing, Inc.

    New York, NY
    4 days ago
  •  ...new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how...  ...will investigate and respond to written or verbal appeals and grievances submitted by members and providers in accordance with Contract... 
    Contract work

    Metropolitan Jewish Health System, Inc.

    New York, NY
    2 days ago
  • $23.17 - $28.96 per hour

    Medicaid Eligibility Coordinator | Hybrid paid time off, tuition reimbursement, 401(k) Overview Provides support to prospective members, members and their families including community resource planning, advocacy, skill building, linking patient/families to community resources... 
    Work experience placement
    Flexible hours

    VNS Health

    New York, NY
    3 days ago
  • Central Nursing is hiring a Business Office Medicaid Coordinator responsible for assisting with Medicaid applications, recertifications, and gathering necessary documentation. You will coordinate with clients, families and the Medicaid Supervisor to ensure accurate submissions... 
    Work at office

    Central-Nursing

    New York, NY
    2 days ago
  • $3,500 per month

    OverviewThe Asset Management Specialist assists, develops, and implements best practices to the market rate, affordable, and student housing...  ...insurance expirations, real estate tax schedules with date of appeals, and lender reporting equirements, etc.)Assists with ensuring... 
    For contractors
    Work at office

    Gilbane Building Company

    New York, NY
    3 days ago
  •  ...in officeQUALIFICATIONS:H.S. diploma/ GED and Certified Peer Specialist (CRPA) Certificate. Knowledge of OASAS rules and regulations and...  ...of Alcoholism and Substance Abuse Services and funded by Medicaid and the NYC Department of Health and Mental Hygiene, serves people... 
    Daily paid
    Full time
    Part time
    Work at office
    Immediate start
    Flexible hours

    Bowery Residents Committee

    New York, NY
    6 days ago
  • $42.64k - $52.41k

     ...Recruiting Certified Peer Specialist for Manhattan Psychiatric Center Apply fast, check the full description by scrolling below to...  ...excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other... 
    Work at office
    Monday to Friday
    Weekend work

    New York State Office of Mental Health

    New York, NY
    6 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Medicaid Appeals & Grievances Specialist. Be the first to apply!