- Mohawk Valley Health System (Utica, NY)
- …palliative care, end-of-life-care and hospice. + Apply knowledge of Health Insurance and Managed Care Programs, along with values- based care, pay-for-performance ... Support education to minimize clinical variability throughout the medical staff . + Assist case managers with Medicare and Medicaid.... + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as… more
- WMCHealth (Valhalla, NY)
- …for developing positive relationships with both employed and affiliated medical staff members in order to fulfill strategic business growth and objectives. ... of the request. + Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals… more
- UHS (Johnson City, NY)
- …and agency standards for approval + Assists with onboarding and training new staff regarding commercial insurance processes, policies, and payer expectations + ... + Uses a customer-focused approach in all interactions with patients, families, staff , and insurance representatives + Escalates unresolved issues appropriately… 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...updating regularly.* Communicating with appellant, divisions, agencies, and higher-level staff on status updates. * Preparing and mailing out… 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,...related to billing and reimbursement activities. **Responsibilities:** + Train staff on standard operating procedures and Clinic Works for… 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
- Excellus BlueCross BlueShield (Buffalo, NY)
- …of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working with the children's population. + Develops, implements, and ... between BH and PH care across the UM/ CM staff . + Participates in clinical peer review recruitment and...BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan… more
- City of New York (New York, NY)
- …ARE PERMANENT (NOT PROVISIONAL) IN THE CIVIL SERVICE TITLE OF ADMINISTRATIVE STAFF ANALYST. The Administration for Children's Services (ACS) protects and promotes ... foster care services and provides subsidized childcare vouchers. ACS child protection staff respond to allegations of child maltreatment. In juvenile justice, ACS… more
- WMCHealth (Valhalla, NY)
- …Job Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using ... role is expected. Does related work as required. Responsibilities: + Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.… more