- Datavant (Albany, NY)
- …to deliver complex healthcare technology solutions. + Solid understanding of clinical suspecting, concurrent coding workflows, risk adjustment models (eg, ... experiences to realize our bold vision for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the… 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 ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … 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 ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Provides clinical expertise on ARD cases, Quality of Care cases, clinical editing, coding reviews and inquiries. + Makes accurate and consistent ... mentor and resource throughout the workday in training medical director colleagues, as needed. + Conduct clinical ...medical director colleagues, as needed. + Conduct clinical appeal case reviews and may require peer-to-peer discussions… more
- Sumitomo Pharma (Albany, NY)
- …highly motivated, and experienced individual for the position of **Associate Medical Director .** The Associate Medical Director will provide hands-on PVRM ... products. + Conduct safety surveillance over product life cycle, reviewing clinical trial and post-marketing Individual Case Safety Reports (ICSRs), including… more
- Ankura (New York, NY)
- …+ Minimum 10 years' health care experience related to clinical care, clinical documentation, compliance, or coding of medical services + Medical coding ... of medical records, the determination of medical necessity and appropriate medical coding , and the computation of financial impacts that may lead to repayments.… more
- CVS Health (New York, NY)
- …Responsible for predetermination reviews ad reviews of claim determinations, providing clinical , coding , and reimbursement expertise, using multiple computer ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources....Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from… 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 ... **Job Description** **Senior Director , Patient Financial Services (Backend) Corporate East 42nd...departments (eg, DTP, Human Resources, Managed Care, Finance, and clinical departments) + Collaborates with finance, managed care and… more
- Mount Sinai Health System (New York, NY)
- …requirements. The CRM works in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and ... the physician documentation for specificity, completeness and quality to support coding accuracy, and to identify physician query opportunities to improve the… more
- Anthony Jordan Health Corp (Rochester, NY)
- DENTAL DIRECTOR ROCHESTER, NY (http://maps.google.com/maps?q=82+Holland+St+ROCHESTER+NY+USA+14605) * Dental Apply Job Type Full-time Description The health services ... and financial success of the dentistry program is achieved. . Clinical outcomes are improved through evidence-based strategies and innovative care approaches.… more