- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Molina Healthcare (Yonkers, NY)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... appeals and denials . + Strong verbal and written communication skills To… more
- Molina Healthcare (Buffalo, NY)
- …for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial ... by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into information system and prepares documentation… more
- Mount Sinai Health System (New York, NY)
- …/ Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical Record requests for denials to ... **Job Description** **Insurance Specialist MSH PT Days 4/Days Week (Days Vary)...the department as per protocol + Requests or provides Medical Records as required for appeals ,… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …status using payer portals and billing software; investigate and resolve rejections or denials promptly. + Prepare and submit appeals for denied claims, ... Job Summary The Billing Specialist plays a critical part in maintaining the...will be responsible for processing the full lifecycle of medical claims-from charge entry and claim submission to payment… more
- Stony Brook University (East Setauket, NY)
- Revenue Specialist **Position Summary** At Stony Brook Medicine, a **Revenue Specialist ** will provide operational support within the hospital's Patient ... business functions including, but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue… more
- Stony Brook University (East Setauket, NY)
- Revenue Specialist **Position Summary** At Stony Brook Medicine, a **Revenue Specialist ** will provide operational support within the hospital's Patient ... business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue… more
- Mount Sinai Health System (New York, NY)
- …data entry of codes. + Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals . Posts denials in IDX on a timely ... **Job Description** The Procedural Billing Specialist I is responsible for multiple components of...+ Associates Degree preferred + 5 years experience in medical billing or health claims, with experience in IDX… more
- Independent Health (Buffalo, NY)
- …Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN ... reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities as well as coordination of all aspects… more
- FlexStaff (Chappaqua, NY)
- **Req Number** 163081 FlexStaff Our client is seeking a skilled Medical Biller/Accounts Receivable Specialist with a minimum of 2 years of experience in ... medical billing, including filing claim appeals . The...in anesthesia or similar specialties - Experience with claim appeals and denials - Strong organizational skills… more