- Cognizant (Albany, NY)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... help you stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is a plus. We're excited to meet people… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on 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...denied due to reasons including, but not limited to clinical documentation/support for diagnostic related grouping (DRG) assignment, inpatient… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …CPT, ICD-10-CM, and HCPCS Level II codes for surgical and clinical procedures, ensuring accurate reimbursement, coding compliance, and efficient billing processes. ... every day. + Accurately review and abstract information from operative and clinical documentation to assign appropriate diagnosis and procedure codes for surgical… 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 ... facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials. **Qualifications** +… more
- University of Rochester (Rochester, NY)
- …and administrative duties in a fast-paced environment in support of clinical , educational, and academic programs. Responsible for all clinic preparations, including ... preferences. Chooses and recommends among competing demands. - Examines the clinical schedule(s) on a continuous basis to identify opportunities for optimizing… more
- Rochester Regional Health (Rochester, NY)
- …requests for cardiology medications, and monitor approvals, step therapy requirements, and appeals to ensure timely access to treatment. + Collaborate with providers ... to gather clinical documentation and assist patients with enrollment in pharmaceutical assistance programs, grants, and co-pay support. + Maintain current knowledge… more