- 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 ... management while optimizing provider patient schedule, coordination of patient care and information/data support. **ESSENTIAL FUNCTIONS** + Serves as primary… more
- Mount Sinai Health System (New York, NY)
- …Case Management FT Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad ... facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials. **Qualifications** +… more
- Rochester Regional Health (Rochester, NY)
- …the Director of Care Management. Provides daily oversight of the onsite review activities of third party payors identifying issues and cases for appeal. + ... of the Medical Management Department to maintain daily operations. Oversees the daily review process of the third party payors ensuring information is tracked and… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …team focused, service driven, accountable, and innovative every day. + Accurately review and abstract information from operative and clinical documentation to ... CPT, ICD-10-CM, and HCPCS Level II codes for surgical and clinical procedures, ensuring accurate reimbursement, coding compliance, and efficient billing processes.… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …+ Thorough review of claims and medical documentation. + Prepare cases for clinical review . + Resolve and provide accurate and timely responses to disputes ... issues. + Strong knowledge of contracts, medical terminology, and appeals processing and procedures. + High School Diploma or...Mission Transform the health plan experience - how health care is accessed and delivered - by bringing outstanding… more
- Intermountain Health (Albany, NY)
- …within Intermountain's policies and procedures. Scope 1.Analyze data, develop reports, review trends, and recommend enhancements as defined by the RI leadership ... responses and activities in collaboration with others involved including the care site teams, external business partners/vendors, compliance, legal counsel, health… more
- University of Rochester (Rochester, NY)
- …closure and obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. ... hospital departments or department representatives. + Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts and… more