- University of Rochester (Rochester, NY)
- …outlined in the NY State Office of Mental Health (OMH) Prior Approval Review (PAR). The Senior Health Project Coordinator will collaborate closely with the Western ... NY Comprehensive Care Center for Eating Disorders Director and Medical Director, as well as The Healing Connection Leadership and Board, to achieve successful… more
- Western Digital (Albany, NY)
- …in San Jose, Irvine or remote. ESSENTIAL DUTIES AND RESPONSIBILITIES: + Review , draft and advise on advertising and marketing materials, including packaging, press ... strong familiarity with intellectual property and privacy matters + Prepare, review , and negotiate complex agreements including those for software licensing,… more
- Healthfirst (NY)
- …productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case ... + Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. +… more
- Highmark Health (Albany, NY)
- …action to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + ... as needed to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. + Engages in delivery of audit results and… more
- Jacobs (Garden City, NY)
- …track and report on, public outreach documents, DBE compliance, and invoice review and processing for payment for client contracts. * Perform record-keeping tasks ... and provide list of approved vendors * monthly. * Review distribute and approve all public facing materials, public...public interactions, and responses * Monitor damage and public claims and ensure satisfactory resolution. * On a monthly… more
- UHS (Johnson City, NY)
- …communication skills and a thorough understanding of insurance requirements. You'll review clinical documentation to confirm it meets agency and payer standards ... assisting in the reconsideration and appeals process for denied claims + Collaborates with clinical and administrative teams to...in data processing + Certified home care and/or utilization review work experience Why You'll Love Working at UHS… more
- Barnes & Noble (New York, NY)
- …factors permitted by law. WhatYouDo: * Coordinate Proposition 65 claims , recalls and similar, including communication, documentation, follow-up, and disposition ... of inventory as determined by Director. * Generate and review product, import, vendor and similar reports for compliance risk assessment daily or weekly at the… more
- Elevance Health (Middletown, NY)
- …I** is responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing incoming calls or ... incoming post services claims work. + Determines contract and benefit eligibility; provides...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the… more
- Cardinal Health (Albany, NY)
- …Health's At-Home Solutions ("AHS") business clients, a leading home healthcare medical supplies provider serving people with chronic and serious health conditions ... AHS business unit is comprised of four complementary business units: (1) Edgepark Medical Supplies, a leading mail order supply company that specialize in serving… more
- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution + Educate offices using approved materials + Review… more