- University of Rochester (Fairport, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and ... determined by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and internal equity… more
- University of Rochester (Rochester, NY)
- …protocols in selecting for routine and non-routine letters of correspondence related to appeals on denied claims , billing and patient communications. + This ... determined by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and internal equity… more
- Independent Health (Buffalo, NY)
- …the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in support of a high performing health plan and ... network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document research of initial coverage determinations, and lead… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... include but are not limited to researching, correcting, resubmitting claims , submitting appeals and taking timely and...and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative … more
- Highmark Health (Albany, NY)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- CVS Health (Albany, NY)
- …team, and measuring success through improved member health as evidenced through Data Analytics. + Assists the customer's Wellness Representative (s) in managing ... navigating them through the health system, providing support on claims issues, and answering coverage-level questions. **We have two...the employees and the customer Total Rewards team on appeals . + Assist the Total Rewards team with the… more
- Saratoga Hospital (Saratoga Springs, NY)
- …entering data into the EMR system, assisting in compiling appeals and reconsiderations. + Collaborate and communicate effectively with employees and PFS ... What You'll Do + Handle and resolve assigned denied claims in multiple work queues including, but not limited...and staff satisfaction. + Serve as a positive, professional representative of our hospital and community. What You Bring… more