Appeals and Grievances Processors and Intake Specialists - New York, New York -

Permanent Nursing Job in
New York , New York, 10017

  • Employer: Robert Half International
  • Profession: Licensed Practical Nurse
  • Specialty: Administrative / Research / Non-Clinical
  • Compensation: 40.00 - 70.00/hour

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Manhattan based nationally known healthcare organization is seeking 5 to 10 people to assist with their Appeals and Grievances process. Ideal consultant will have 3+ years experience in reviewing appeals and grievances as it relates to healthcare organizations.. Knowledge of intake and classification of appeals & grievances important as well as the ability to work the cases individually. Prior knowledge of medical coding helpful and ideally experience and technical knowledge of procedures, tests etc. Opportunity is long term, possible project to hire.
Duties include as follows:
Send acknowledgment of claims, grievances/appeals to members and organizations. Research claim denials and make sure providers understand their policy of agreement and fee schedules using -contracted DRG outliers, CPT, ICD-10, HCPCS codes; UB-04 fields and utilize our claims reimbursement team under the appropriate line of business in order to resolve cases.
-Send acknowledgement and determination notices. Request documents from providers such as waivers, explanation of payment/benefits. Follow up with internal counterparts and departments for information as necessary. Assemble and forward case documentation once research is concluded. Create and submit CPT coding to clinical nurses and set detailed upheld, dismissal or ineligible notices

Job Requirements

Appeals & Grievances Experience, Experience with Medicaid preferred.


New York, New York , 10017

Employment Type



40.00 - 70.00/hour


Robert Half International

Date Posted

Jan 3rd, 2019

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