- Evolent (Albany, NY)
- …Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. + Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... final resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of...western New York, Rochester is our namesake and our home . One of the world's leading research universities, Rochester… more
- MVP Health Care (Tarrytown, NY)
- At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, ... well-being + An opportunity to shape the future of health care by joining a team recognized as a...delivery system, including but not limited to Medicaid and Medicare benefits. + The overall objective is to create… more
- Catholic Health Services (West Islip, NY)
- …organizations, and discharge planning is required. Current knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. ... Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient care data to… more
- Evolent (Albany, NY)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation, coding ... Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + Proficient… more
- Evolent (Albany, NY)
- …Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- …Proficiency . Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Amgen (New York, NY)
- …on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). + Act as an extension of the HUB, ... through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested… more