- 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
- 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)
- … Clinical /Technical/Service** + Demonstrates the ability to perform clinical /technical/service/administrative tasks: + Prioritizes Insurance Requests / Denials ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical Record requests for… more
- Mount Sinai Health System (New York, NY)
- …facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials . ... **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position...Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support… more
- Trinity Health (Syracuse, NY)
- …denial coordination with Patient Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis ... charge errors accordingly. Epic experience desired.Experience and knowledge of working on appeals for insurance denials and identifying root cause.Knowledge of… more
- Trinity Health (Syracuse, NY)
- …denial coordination with Patient Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis ... charge errors accordingly. Epic experience desired. Experience and knowledge of working on appeals for insurance denials and identifying root cause. Knowledge of… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …clarify documentation and ensure code accuracy. + Monitor and respond to coding-related denials , rejections, and edits; assist with appeals and identify areas ... CPT, ICD-10-CM, and HCPCS Level II codes for surgical and clinical procedures, ensuring accurate reimbursement, coding compliance, and efficient billing processes.… more
- Mohawk Valley Health System (Utica, NY)
- …+ Provide guidance and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. ... potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals… more
- University of Rochester (Rochester, NY)
- …GENERAL PURPOSE Serves as the patient referral and prior authorization specialist , with oversight of data and compliance to enterprise standards and ... referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non- clinical staff, identifying barriers to appointment… more