- CenterWell (Albany, NY)
- …responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials . Works with branch staff to gather required ... to develop appropriate and timely responses. + Responsible for constructing response to denials and appeals , utilizing any federal guidelines or local coverage… more
- BronxCare Health System (Bronx, NY)
- …for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely ... tracking and trending of all denials and appeals , prepare weekly status reports, attend necessary meetings to assist the department attain its objective of… more
- Molina Healthcare (Yonkers, NY)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing... appeals and denials . + Strong verbal and written communication skills +… more
- Molina Healthcare (Yonkers, NY)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act… more
- Rochester Regional Health (Rochester, NY)
- …or no appeal is necessary per UM reviews. + Track and monitor all denials , appeals , arbitration responses to payers/audits. + Participates in periodic denial ... - Friday, Days SUMMARY: Review all inpatient medical necessity denials for the health system based on InterQual and/or...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
- WMCHealth (Valhalla, NY)
- …expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals as required to overturn denials . + Provides assistance to initial ... to discuss cases and problems. + Participates in daily review of aggregate denials / appeals with the Medical Director, peer, or the Clinical Review Supervisor. +… more
- Robert Half Accountemps (Cheektowaga, NY)
- …effectively in a fast-paced environment. * Utilize medical billing expertise to handle denials , appeals , and hospital billing processes. Requirements * 1-3 years ... abilities. * Familiarity with medical billing processes, including collections, denials , and appeals . * Ability to quickly learn and adapt to internal… more
- Centene Corporation (New York, NY)
- …and coordinate the medical affairs functions for the business unit. Oversee the denials and appeals department. May manage other medical directors. Assume VPMA ... ad hoc committees. + May oversee all aspects of the Appeals and Denials department including implementing budgetary, policy, and personnel decisions for the… more
- Independent Health (Buffalo, NY)
- …Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN ... coding complexity. They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise and proficiency demonstrated… more
- Crouse Hospital (Syracuse, NY)
- …Care Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to ... Business Office staff regarding workflow processes and maintains an effective denials management process. + General operational oversight includes hiring, training… more