- WMCHealth (Valhalla, NY)
- …of the request. + Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals ... to discuss cases and problems. + Participates in daily review of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor. +… more
- UHS (Johnson City, NY)
- …OverviewUnited Health Services (UHS) is seeking a detail-oriented and proactive Commercial Insurance Liaison to join our team. In this critical role, you will ... services provided to patients with commercial or managed care insurance plans. Your work helps ensure timely access to...and Compliance teams by assisting in the reconsideration and appeals process for denied claims + Collaborates with clinical… more
- University of Rochester (Rochester, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500183 Health Insurance Counseling Work Shift: UR - Day (United States of America) Range: UR ... are worked daily and are followed up appropriately. + Assist with third-party appeals at advanced levels escalated by staff. + Lead and evaluate task activities… more
- Aspen Dental (East Syracuse, NY)
- …to join our dedicated team as a **Revenue Cycle Management (RCM) Lead for Insurance Processing** based in East Syracuse, NY. The Revenue Cycle Management (RCM) Lead, ... Insurance Processing will support departmental operations by evaluating, training,...claims, electronic claim rejections and resubmissions, denials, secondary claims, appeals , error corrections, claim review and supporting systems (ICS… more
- FlexStaff (Chappaqua, NY)
- …of 2 years of experience in medical billing, including filing claim appeals . The ideal candidate will have strong organizational skills, excellent attention to ... denied or incorrectly paid claims. Key Responsibilities: - Review insurance payments for accuracy based on fee schedules -...accuracy based on fee schedules - Prepare and submit appeals for underpaid or denied claims - Follow up… more
- New York State Civil Service (Albany, NY)
- …are reviewed and processed in a timely fashion, particularly on the matter of appeals . The Civil Service Commission (CSC) is an independent body that hears and ... determines appeals submitted by candidates, state employees, state agencies, or...performance assessment tests.* Administers the New York State Health Insurance Program (https://www.cs.ny.gov/nyship/), one of the largest public employer… more
- Centene Corporation (New York, NY)
- …medical affairs functions for the business unit. Oversee the denials and appeals department. May manage other medical directors. Assume VPMA responsibility in ... medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . + Participate in provider network development and new market expansion as… more
- Mount Sinai Health System (New York, NY)
- …health claims, with experience in IDX billing systems in a health care or insurance environment, and strong familiarity with ICD/CPT coding + Licensing: None but CPC ... balances. + Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including… more
- Humana (Albany, NY)
- …include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The ... other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. +… more
- Humana (Albany, NY)
- …include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The ... other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. +… more