- Molina Healthcare (NY)
- …by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into information system and prepares documentation ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- New York State Civil Service (Queens Village, NY)
- …and assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... management, development, and oversight of services.* Providing full range of clinical and administrative supervision to subordinate staff; may act as shift supervisor.* Participating in clinical leadership and in committees or work groups as assigned.*… more
- Guthrie (Corning, NY)
- …for review and determination of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor and Review REMS clearance ... for monthly refills of high-risk medications ordered for patients Monitor and Manage Department in Basket * *E-Guthrie Medical Advice Requests * *Medication Cancellation notifications * *Electronic Refill Requests * *System generated Medication Authorization… more
- WMCHealth (Valhalla, NY)
- …role is expected. Does related work as required. Responsibilities: + Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement. ... Job Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …status using payer portals and billing software; investigate and resolve rejections or denials promptly. + Prepare and submit appeals for denied claims, ... and provider narratives as needed. + Identify and report trends in denials , underpayments, and billing errors to support performance improvement. + Generate and… more
- Trinity Health (Syracuse, NY)
- …charge errors accordingly. Epic experience desired. Experience and knowledge of working on appeals for insurance denials and identifying root cause. Knowledge of ... Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed. Educates… more
- Trinity Health (Syracuse, NY)
- …charge errors accordingly. Epic experience desired.Experience and knowledge of working on appeals for insurance denials and identifying root cause.Knowledge of ... Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed.Educates clinical… more
- Humana (Albany, NY)
- …_Outcomes_ : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. Deliver the upmost consistent ... medical director decision making. + _Internal Operations and Technology_ _:_ Support efforts to improve the efficiency of health plan operations (utilization management and provider clinical contracting) to reduce friction for members, providers, and… more
- Catholic Health Services (Melville, NY)
- …Managed Care payors and regulatory bodies as needed. Supports system-wide efforts in denials management, root cause analysis, and appeals Analyzes trends in care ... Commission standards, and state regulations. Understanding of managed care contracts, appeals processes, and denial management. Awareness of trends in population… more
- Mount Sinai Health System (New York, NY)
- …Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical Record requests for denials to insure that ... ability to perform clinical/technical/service/administrative tasks: + Prioritizes Insurance Requests / Denials when received in the department as per protocol +… more