- Excellus BlueCross BlueShield (Rochester, NY)
- …Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization ... to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in addition to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical information ... facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials. **Qualifications** +… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …Monitor and respond to coding-related denials, rejections, and edits; assist with appeals and identify areas for process improvement. + Collaborate with the billing ... team and other departments to resolve discrepancies and optimize revenue cycle performance. + Participate in internal audits, meet coding accuracy benchmarks, and stay current with coding regulations, payer updates, and orthopedic-specific policies. + Answer… more
- MetLife (Oriskany, NY)
- …and thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. Essential Business Experience and Technical ... Skills: Required: * New hires should live a commutable distance from the site the role is posted in * High School Diploma * Minimum 2 years of experience in external customer service or related experience * Demonstrated critical thinking in activities… more
- University of Rochester (Rochester, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims, including compiling all necessary information and drafts ... for provider signature. + Manages provider(s) documentation and information. + Composes and types of non-routine correspondence providing factual information. + Arranges travel, conference registration, and hotel accommodations. Interfaces with organizations,… more
- New York Health Care (Valley Stream, NY)
- …necessary adjustments, while communicating these changes to the contract and filing appeals when necessary. + Correct system issues pertaining to billing, patients ... and or caregivers as directed by management. + Requirements: + Previous collections experience with proven results. + Strong analytic skills with advanced problem solving ability. + Excellent organizational skills with attention to detail. + Intermediate… more
- University of Rochester (Rochester, NY)
- …edits and obtains signatures for non-routine letters of correspondence related to appeals on denied claims. This includes compiling all necessary information and ... drafts for provider signature. - Manages provider(s) documentation and information. Composes and types non routine correspondence providing factual information. - Arranges travel, conference registration and hotel accommodations. Interfaces with organizations,… more
- Mohawk Valley Health System (Utica, NY)
- …and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. Apply knowledge of ... throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as a liaison with payers… more
- CDPHP (Latham, NY)
- …and quality standards and adhering to prompt pay regulations. The specialist will address and resolve service-related issues including claim adjustment requests, ... appeals and complaints, eligibility determination and other claims related...advising the customer of their rights and responsibilities. The specialist will also respond to inquiries received via written… more
- WMCHealth (Valhalla, NY)
- …Job Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the ... role is expected. Does related work as required. Responsibilities: + Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement. +… more