- Lincoln Financial (Albany, NY)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. Experience with MCG… more
- Cognizant (Albany, NY)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Medicare, Medicaid, and third-party guidelines. . Effectively document and log claims/ appeals information on relevant tracking systems . Utilize critical thinking… more
- Molina Healthcare (Syracuse, NY)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Molina Healthcare (Buffalo, NY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Catholic Health (Buffalo, NY)
- …role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting ... the appeals process for denied claims denied due to reasons...one of the following (or similar) credentials: Certified Documentation Specialist , Certified Coder (CPC/CCS), Certified Processional Medical Auditor (CPMA),… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist MSH PT Days 4/Days Week (Days Vary) 8a-1p with Every Weekend** To maintain front end operations of the Case Management ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements.../ Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and… more
- Independent Health (Buffalo, NY)
- …fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical decisions on ... They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise...audit tips across the team. The Clinical & Coding Specialist -Senior will support the leadership in Hospital Audit in… more
- Robert Half Accountemps (Stony Brook, NY)
- Description We are looking for a dedicated Medical Billing Specialist to join our team! This position offers an opportunity to become a full cycle Revenue ... Specialist involved in all aspects of medical billing, coding, appeals , denials, and claims. Willing to train but prefer a certification in medical billing/coding… more
- FlexStaff (Chappaqua, NY)
- **Req Number** 159695 FlexStaff Our client is seeking a skilled AR Specialist / Biller with a minimum of 2 years of experience in medical billing, including filing ... claim appeals . The ideal candidate will have strong organizational skills,...accuracy based on fee schedules - Prepare and submit appeals for underpaid or denied claims - Follow up… more