- Northwell Health (Mount Kisco, NY)
- …clinical course. + Ensures compliance with current state, federal, and third party payer regulations. + Documents the case management process in the medical record; ... specialty, service line, years of relevant experience, education, credentials, negotiated contracts , budget and internal equity). The salary range for this position… more
- Cardinal Health (Albany, NY)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... employee schedules to ensure proper business coverage as outlined by client contracts and company policies. **Qualifications:** + Bachelor's degree in related field,… more
- Catholic Health Services (Melville, NY)
- …staff and other health team members to understand and help comply with payer / contract issues and appeal preparation. Maintains strict standards for patient ... Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according to industry… more
- Centene Corporation (New York, NY)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides education to members and their families on ... Professional (eg, LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required Pay Range: $73,800.00 - $132,700.00 per year… more
- Trinity Health (Syracuse, NY)
- …market relevant, including overseeing the implementation and monitoring of adherence to payer contracts and procedures. Provides effective use of system ... needed to support accurate, consistent, and compliant professional revenue operations. The Manager will have an A2 relationship to both the Regional Vice President… more
- The Cigna Group (New York, NY)
- …to solve outstanding claim issues + Must be able to read and understand a payer /client contract + Works payer projects, with short timelines + Demonstrated ... claims rejected and/or denied by system edits and or payer . This role will support 10+ direct reports with...denials experience preferred + 5+ years of supervisor or manager experience preferred + 2+ years minimum of front… more
- Catholic Health (Buffalo, NY)
- …and outpatient medical necessity. The individual also works to maintain third-party payer relationships. This includes, but is not limited to, responding to ... between parties. Knowledge of state and federal laws relating to contracts and appeal processes is vital. Additional responsibilities include identification of… more
- Albany Medical Center (Albany, NY)
- …- required + Computer skills (High proficiency) + Insurance knowledge regarding payer contract interpretation including Authorization Requirements and Setting of ... be able to work in conjunction with Nursing Supervision and Patient Triage Manager for accurate bed assignment for inpatient and observation patients. In addition,… more
- Mount Sinai Health System (New York, NY)
- …Street - Full-Time Days** Under the supervision of the Patient Financial Supervisor/ Manager , performs a variety of patient accounting functions, including but not ... accounts (billing) using PFS HIS Systems, Clearing House Claim Scrubber and/or any payer websites available for claim correction of billed accounts. + Bill claims to… more
- University of Rochester (Rochester, NY)
- …compliance with State and Federal Regulations, accreditation standards and third-party payer requirements for the purpose of minimizing risk and exposure. This ... business, market growth, service development and payor/PBM strategies. + Participates with payer contracting leaders of the health system in the evaluation and… more