- Mount Sinai Health System (New York, NY)
- …Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements...of the hospital staff and extended community. + Notifies Supervisor of obstacles / problems affecting the completion of… more
- WMCHealth (Valhalla, NY)
- …of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor . + Provides continuous education to physicians as needed ... within the regulatory timeframe of the request. + Provides clinical rational for standard and expedited appeals ....Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or… more
- MTA (Brooklyn, NY)
- …SALARY : $ 190,000 - $ 195,000 DEPT/DIV: HQ/ Occupational Health Services (OHS) SUPERVISOR : Assistant Medical Director HOURS OF WORK: 7.5 hours per day LOCATION: 300 ... 3 days per week serving on the Paratransit Eligibility Appeals Board. The physician will provide medical expertise and...cases. + Work with Assistant Medical Director and other clinical staff members as needed on for medical policy… more
- Rochester Regional Health (Rochester, NY)
- Summary: Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by effectively ... phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed...and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to… more
- Rochester Regional Health (Rochester, NY)
- …Riedman Campus SUMMARY: Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by ... phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed...and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to… more
- University of Rochester (Rochester, NY)
- …direction to other secretarial staff and clerical staff. Serves as an indirect supervisor of OAR staff. May train and coordinate activities of peers or support ... staff. **ESSENTIAL FUNCTIONS** + Examines the clinical schedules(s) on a continuous basis (both weekly and...for routine and non-routine letters of correspondence related to appeals on denied claims, billing and patient communications. +… 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
- Elderwood (Liverpool, NY)
- …our Pay in Lieu of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package + 401k PLUS Employer ... for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix...reference them. + Performs other duties as assigned by supervisor , management staff or Administrator. Qualifications RN - MDS… more
- Elderwood (Cheektowaga, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the ... and HIPAA policies. + Performs other duties as assigned by supervisor , management staff or Administrator. Qualifications Managed Care Coordinator Educational… more