- Humana (Albany, NY)
- …**Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Amgen (New York, NY)
- …supporting the entire reimbursement journey through payer prior authorization to appeals /denials requirements and forms + Review patient-specific information in ... in the public or private third-party access arena or pharmaceutical industry in managed care , clinical support, and/or sales OR Master's degree AND 6 years of… more
- Elevance Health (New York, NY)
- …make an impact:** + Determines the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization ... ** Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery**...practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging… more
- Elevance Health (Latham, NY)
- …focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve._ The ** Clinical Operations Associate Medical ... years of clinical experience post residency. Preferably in inpatient post-acute care + Board certified in Physical Medicine and Rehab is preferred. For… 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 ... ways to improve a complex business process. RESPONSIBILITIES: + Review and accurately process claim edits in a system...phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed… 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 ... a complex business process. STATUS: LOCATION: DEPARTMENT: SCHEDULE: Key Responsibilities: + Review and accurately process claim edits in a system work queue.… more
- University of Rochester (Fairport, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500922 Eastside Primary Care Work Shift: UR - Day (United States of America) Range: UR URCD 204 ... secretarial and administrative duties in a fast-paced environment supporting clinical , educational, and academic programs. Responsible for all clinic preparations,… more
- Mount Sinai Health System (New York, NY)
- …AR trends and billing lags. + Collaborate with department such as coding, IT, clinical service areas and appeals to ensure seamless end-to-end revenue cycle ... routine meetings with health system business leaders and managed care to review payer issues and denials....key stakeholders across departments (eg, DTP, Human Resources, Managed Care , Finance, and clinical departments) + Collaborates… more
- Crouse Hospital (Syracuse, NY)
- …case management/ discharge planning in an acute care setting or other care continuum experience in a clinical setting + Knowledge of regulatory requirements ... related to acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical, Dental, Vision, FSA, and 401K.… more
- University of Rochester (Dansville, NY)
- …and administrative duties in a fast-paced environment in support of clinical , educational, and academic programs. Responsible for all clinic preparations, including ... management while optimizing provider patient schedule, coordination of patient care and information/data support. SUPERVISION AND DIRECTION RECEIVED: Receives… more