- Trinity Health (Syracuse, NY)
- …are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer ... Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed.Educates clinical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Billing Specialist is responsible for multiple components of the billing & coding process, including Accounts Receivable, Charge Entry, Edits ... relevant experience + Certified coder required + Experience in medical billing or health claims, with experience in EPIC...and work missing charges, edits, denials list and process appeals . Posts denials in EPIC/IDX on a timely basis.… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …on your preference.** Job Summary We are seeking a detail-oriented and experienced Medical Coder/Biller to join our Ambulatory Surgery Center (ASC) team. This role ... Monitor and respond to coding-related denials, rejections, and edits; assist with appeals and identify areas for process improvement. + Collaborate with the billing… more
- Cardinal Health (Albany, NY)
- …+ Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Cell/Gene therapy and/or Oncology experience, preferred +… more
- CVS Health (Albany, NY)
- … adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all… more
- University of Rochester (Rochester, NY)
- …computer, calculator, telephone, facsimile. Will use software for electronic medical record system, appointment scheduling system, and Operating Room scheduling ... edits and obtains signatures for non-routine letters of correspondence related to appeals on denied claims. This includes compiling all necessary information and… more
- CVS Health (Albany, NY)
- …by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify ... complex non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is… more
- Intermountain Health (Albany, NY)
- …providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding ... and billing requirements. + Demonstrates strong knowledge and understanding of medical terminology, medical acronyms, pharmacology, anatomy and physiology and… more
- Rochester Regional Health (Rochester, NY)
- …requests for cardiology medications, and monitor approvals, step therapy requirements, and appeals to ensure timely access to treatment. + Collaborate with providers ... QUALIFICATIONS: + 2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification. PREFERRED QUALIFICATIONS: + Associates… more
- Mohawk Valley Health System (Utica, NY)
- …and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. Apply knowledge of ... planning, patient status changes, length of stay, patient monitoring practices, medical necessity concepts and associated regulations in case management decisions.… more