- Molina Healthcare (Syracuse, NY)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Molina Healthcare (Rochester, NY)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Molina Healthcare (Syracuse, NY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Molina Healthcare (Buffalo, NY)
- …**Provider No Surprise Act** cases outcomes. . * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... * At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. *… more
- Molina Healthcare (Buffalo, NY)
- …* Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides training, ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal ...proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing & Denials Specialist Department: Patient Financial Services Location: SLH - Regional Administrative Campus Hours Per Week: 40 ... Schedule: 8am-4pm SUMMARY: A Medical Billing and Denials Specialist is responsible...fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing: Submits and follows up on insurance claims;… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … Medical Services division. Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of ... programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in addition to Level II… more
- Helio Health Inc. (Syracuse, NY)
- Overview To support the mission of Helio Health, Inc., the Billing Specialist generates medical invoices, posts cash receipts, follows up on accounts receivable ... and any other duties as required to accomplish medical billing for Helio Health. The Billing Specialist...research and documentation. + Researches open claims and processes appeals when necessary. Follows up on patient and insurance… more
- FlexStaff (Chappaqua, NY)
- …AR Specialist / Biller with a minimum of 2 years of experience in medical billing, including filing claim appeals . The ideal candidate will have strong ... accuracy based on fee schedules - Prepare and submit appeals for underpaid or denied claims - Follow up...as assigned Qualifications: - Minimum of 2 years of medical billing experience, specifically in anesthesia or similar specialties… 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