- 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
- MetLife (Oriskany, NY)
- …provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other ... attorneys, clinical/vocational consultants as needed to gather data such as medical /occupational information in order to ensure reasonable, thorough decisions. *… 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
- Mount Sinai Health System (New York, NY)
- …is preferred. **Minimum Certification Requirements** + NAMSS Certified Provider Credentialing Specialist (CPCS), Required + NAMSS Certified Professional Medical ... **Job Description** **Director Medical Affairs Operations- Medical Staff Services -Full-Time...Staff Bylaws, Policies, Corrective Actions, FPPE, OPPE, Hearing & Appeals , etc.) is required. + 10+ years progressive experience… more
- Evolent (Albany, NY)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional ... endovascular procedures, implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a subject matter… more
- CDPHP (Latham, NY)
- …and quality standards and adhering to prompt pay regulations. The specialist will address and resolve service-related issues including claim adjustment requests, ... appeals and complaints, eligibility determination and other claims related...advising the customer of their rights and responsibilities. The specialist will also respond to inquiries received via written… more
- WMCHealth (Valhalla, NY)
- …addressing appeals to insurance companies and coding highly complex medical records using the current International Classification of Diseases (ICD10 CM/PCS ... role is expected. Does related work as required. Responsibilities: + Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement. +… more
- Garnet Health (Middletown, NY)
- …CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical ... day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate...department. The Manager ensures that reviews of the patient's medical data are conducted to assess appropriateness and … more
- University of Rochester (Rochester, NY)
- …company barriers and tracking all assistance provided. Accountable for planning, execution, appeals and efficient follow through on all aspects of the process which ... any discrepancies and/or answer any questions. + Escalates case management when medical assessment is needed. + Prioritizes referral requests using medical … more
- City of New York (New York, NY)
- …of the Office of Equal Employment Opportunity, at ###@health.nyc.gov or ###. CITY MEDICAL SPECIALIST (PART- - 53040 Qualifications Possession of a valid license ... and wellness of students. - Complete Accommodation Reviews and appeals (Home Instruction, Transportation/ Medical Exception, Diabetes Medication Administration… more