- University of Rochester (Rochester, NY)
- …to insurance companies to determine reason for claim denial or reason for unpaid claim . Address unpaid claims , and solicit a payment date from the payer. - - ... - Research and calculate underpaid or overpaid claims ; determine final resolution.- - - Re-calculate claim based on fee schedule, APC or APG grouper, appropriate… more
- University of Rochester (Rochester, NY)
- …which have not been collected through routine billing and collection activities. Claim Resolution Rep III will make independent decisions as to the processes ... necessary to collect denied insurance claims , no response accounts, and will investigate resolving billing...to the attention of billing Manager and Supervisor. The Claim Resolution Rep III will represent the department and… more
- Highmark Health (Buffalo, NY)
- …gain/risk share contract parameters. This includes analysis and interpretation of claims submission for superior coding accuracy, cost and utilization reports, ... medical loss ratio reports, Medicare STARS gaps and other risk revenue opportunities. + Function as the Organization's key contact on gain/risk share multi-disciplinary team. This includes presentation of program results to both internal and external… more
- Acosta Group (Vestal, NY)
- …to perform the essential duties. _Responsibilities With Regard to Workers' Compensation Claims :_ You are responsible for reporting all employment related injury you ... incur to your direct supervisor as soon as possible following an incident resulting in an injury. **QUALIFICATIONS** _Education/Experience:_ High school diploma or general education degree (GED); or one to three months' related experience and/or training; or… more
- Molina Healthcare (Albany, NY)
- …credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. * ... Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. * Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have… more
- ThermoFisher Scientific (Rochester, NY)
- …and documentation. + Support material change risk assessments and verify product claims align with global industry standards (ISO 10993, USP, Pharm Eur, ICH ... food contact, BSE/TSE, etc). + Review and approve product development reports, non-conformance reports, product changes, and new product data entry. + Provide customer regulatory support for compliance requests and resolve product non-conformities, product… more
- City of New York (New York, NY)
- …Justice system. Assist clients with the completion of and filing of victim compensation claims with the State Office of Victim Services. Prepare letters and forms to ... assist with other entitlements. Advocate with public and private agencies. Escort clients to court and confer with assistant district attorneys. Manage case data and related preparation and submission of statistical data. Fieldwork is required. All other… more
- University of Rochester (Rochester, NY)
- …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, hospitals and… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …products used in orthopedic practice. + Knowledge of medical insurance claims procedures and documentation. + Excellent communication, organizational and business ... management skills required. Physical Demands + Requires heavy physical work; heavy lifting, pushing, or pulling required of objects up to 50 pounds occasionally. + Involves standing, walking, and kneeling. Physical work is a primary part (more than 70%) of… more
- SUNY Upstate Medical University (Syracuse, NY)
- …inbound inquires related to prior authorizations and assists billing group on insurance claims . Completes outbound calls to payors and clinics to assist with prior ... authorizations. + Verifies insurance coverage related to prior authorizations by phone, online or through E1 (electronic system) transactions for all new patients and/or changes in coverage. + Enters patient insurance information under the patient's account in… more