- CVS Health (Albany, NY)
- …written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all ... payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains… more
- Knowledge Builders Inc. (Albany, NY)
- …communication skills. Perform related duties as required: * Screen requests for External Appeals in accordance with the Federal No Surprise Act. * Screen requests ... for External Appeal in accordance with Insurance Law, Regulation, and the established protocols. * Act as liaison using written and verbal communication for administrative processes with consumers and representatives of financial entities. * Keep electronic… more
- Elderwood (Hamburg, NY)
- …to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by ... the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator. Responsibilities Managed Care Coordinator Essential Job Fuctions + Able to successfully interact with HMO Case Managers in a professional manner. + Duties include… more
- New York State Civil Service (Albany, NY)
- …the proceeding, examining evidence, preparing briefs, negotiating settlement, preparing appeals and advising superiors; and* Assists or personally conducts hearings, ... as Hearing Officer or Referee or other presiding officer, relating to matters of concern to the agency or on behalf of other jurisdictions. Minimum Qualifications Appointment Method:Minimum Qualifications:Senior Attorney SG-25: One year as an Assistant… more
- Mount Sinai Health System (New York, NY)
- …and procedures. + May run and work missing charges, edits, denials list and process appeals . Posts denials in IDX on a timely basis. + Posts all payments in IDX ... using approved methodologies. + May perform specialty coding for services and medical office visits and review physician coding and provide updated to physicians and staff. + Works TES, BAR and eCommerce edits for the division, department and physicians.… more
- WellLife Network (Elmont, NY)
- …and operate systems skillfully to track the stages of benefit applications and appeals processes that will provide concrete statistical data. The EES Specialist must ... be resourceful by providing consumers with options and have the ability to explain the possible consequences regarding that consumer's specific financial situation. The EES Specialist will act as a liaison between the consumer and governmental agencies, until… more
- Elevance Health (New York, NY)
- …a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any ... embassy located in or outside of the US. + A minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * _For Health Solutions and Carelon organizations (including behavioral… more
- Axis (New York, NY)
- …of claims and litigation management, dispute resolution processes, and trials and appeals as well as excellent analytical, investigative, and negotiating skills < ... >Travel is associated with this role (off-site meetings, court proceedings, mediations) **Benefits and Beyond** At AXIS, we recognize that in order to be an industry leader, we need the dedication and accomplishments of our people, which is why we offer… more
- Insight Global (New York, NY)
- …of a case to the discovery period through trial and post-trial findings and appeals . The paralegal will work with various partners at the firm and mentor junior ... paralegals. Responsibilities: * Organize documents and coordinate document productions. * Conduct research regarding potential new cases and entities, create and maintain internal case databases, and run searches in both internal and external databases. *… more
- Garnet Health (Middletown, NY)
- …a must, with knowledge in Revenue/CPT Code descriptions and the ability to write appeals for denials is required. Should know the statutes and CMS regulations that ... impact the collection of patient's accounts. Frequent contact with insurance companies and Revenue Cycle Depts. Proficient knowledge in Patient Registration, Credit & Collection and medical related software and computer systems. Three years related work… more