- SUNY Upstate Medical University (Syracuse, NY)
- …and recommending and coordinating corrective actions. Review orders for appropriate clinical indications and provide ICD-10 coding . Monitor new ... insurance demographic information and medical necessity pertaining to documentation and coding . Will interact with referring physicians, patients, hospital and MSG… more
- Mount Sinai Health System (New York, NY)
- …touches, aged AR trends and billing lags. + Collaborate with department such as coding , IT, clinical service areas and appeals to ensure seamless end-to-end ... across departments (eg, DTP, Human Resources, Managed Care, Finance, and clinical departments) + Collaborates with finance, managed care and DTP contributors… more
- SUNY Upstate Medical University (Syracuse, NY)
- …all endoscopy and procedural procedures and assures that all of the appropriate clinical , equipment and insurance coding information is collected for the surgery ... schedule. Scheduler receives requests to schedule procedures from physician offices and schedules the procedure according to established guidelines and policies. Scheduler provides accurate information so that all departments may view daily, and maintains open… more
- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Humana (Albany, NY)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Albany, NY)
- …discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Albany, NY)
- …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference… more
- Catholic Health Services (Smithtown, NY)
- …- to every resident and patient, every time. Job Details Summary: The Clinical Reimbursement and Quality Management plays a vital role in ensuring accurate ... care and ensuring compliance with regulatory standards. Key Responsibilities: Clinical Reimbursement: + Documentation: Review and analyze resident documentation to… more
- BronxCare Health System (Bronx, NY)
- Overview The Clinical Documentation Specialist will work with Senior Director in physician education regarding documentation that meets severity of illness/intensity ... hospital top DRG's to insure that documentation is optimal and meets coding clinic guidelines in order insure optimal hospital reimbursement. Prepares and presents… more
- MVP Health Care (Tarrytown, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Clinical Investigator** to join #TeamMVP. This is the opportunity for you if ... professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A… more
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