- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. Experience with MCG… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute ... action in order to improve outcomes. - Maintains an excel log related to denials / appeals activities in order to monitor successful appeals . - Assists with… more
- Molina Healthcare (Buffalo, NY)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving... appeals and denials . + Strong verbal and written communication skills To… 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** Responsible for reviewing and resolving... appeals and denials . + Strong verbal and written communication skills To… 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
- GMHC (New York, NY)
- …programs. + Ability to advise and represent clients in benefits-related disputes, denials , appeals , and overpayment matters. Strong documentation and compliance ... skills, ensuring: + Detailed and accurate legal records, case notes, and service plans in compliance with HIPAA and applicable funder standards. + Ongoing confidentiality and adherence to legal and regulatory standards in all documentation and interactions.… more
- Guthrie (Binghamton, NY)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . Assesses and coordinates discharge planning needs ... with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this… more
- WMCHealth (Suffern, NY)
- …to the hospital to ensure patient has coverage, services provided are covered, denials and appeals minimized and payments are expedited. + Reviews registration ... data for accuracy and satisfying delinquent data for a quality assurance. + Handles the printing and distribution of Admission/Registration forms, face sheets, labels and NY State and Federally mandated forms to patients or nursing unit as appropriate. +… more