- Mount Sinai Health System (New York, NY)
- …appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Albany, NY)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Centene Corporation (New York, NY)
- …Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +...package may include participation in group health and/or dental insurance , retirement plan, wellness program, paid time away from… more
- Mount Sinai Health System (New York, NY)
- …current insurance coverage. 5. Collaborates and participates in the appeals process with all members of the interdisciplinary team. 6. Collaborative ... collaboratively with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating… more
- Ellis Medicine (Schenectady, NY)
- …in MIDAS per policy. + Prints/copies the chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with ... files, updating referral information, and verifying information related to health insurance or benefits. Role requires interaction with clients, payers, post-acute… more
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... license in the state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient Calls Incoming and… more
- Guthrie (Corning, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience in nursing, ... license in the state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient Calls Incoming and… more
- Bassett Healthcare (Cooperstown, NY)
- …follows up as indicated. + Communicates with Finance Department on issues of insurance , denials, authorizations and self-pay issues as needed + Interfaces with IPRO ... and financial indicators including LOS, excess days, resource utilization, denials and appeals , swing bed statistics. + Uses data to drive decisions and… more