- Molina Healthcare (Rochester, NY)
- …Claim Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from… more
- Molina Healthcare (Rochester, NY)
- …proactively identifying, validating, and tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical Operations will also have oversight ... and programs. **Job Summary:** Reporting to the Director of Operations, the Manager of Compliance and Clinical Operations is responsible formaintaining an… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Clinical Risk Manager in the Department of Risk Management and Patient Safety is responsible for the day to day risk management ... of Health and conducting risk management educational programs. The Clinical Risk Manager is responsible for the...Cause Analysis investigations, which includes assessing need for focused review by departments, and or clinical chairpersons… more
- Elevance Health (Latham, NY)
- … documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Albany, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist-Senior will be responsible for reviewing coding and … more
- Walgreens (Wading River, NY)
- …of medications and drug interaction awareness. Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient outcome ... (eg patient consultation, medication management, drug therapy reviews, and perform clinical , or wellness services such as immunizations, diagnostic testing, and… more
- Oak Orchard Health (Brockport, NY)
- Revenue Cycle Manager Brockport, NY (http://maps.google.com/maps?q=300+West+Avenue+Brockport+NY+USA+14420) Job Type Full-time Description Do you want to be part of a ... the third-party billing organization to ensure proper processing of all payer claims . This would include research for accuracy, analyze reports, follow through… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental… more