- Elevance Health (Latham, NY)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more
- Public Consulting Group (Albany, NY)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… more
- Mount Sinai Health System (New York, NY)
- …+ Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare ... Conducts Root Cause Analysis investigations, which includes assessing need for focused review by departments, and or clinical chairpersons for peer reviews. 5.… more
- Arnot Health (Elmira, NY)
- …Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and ... discourage preventable denials DUTIES AND RESPONSIBILITIES: 1. Retrospectively determines medical necessity and appropriateness of admission and stay in accordance… more
- GE Vernova (Schenectady, NY)
- …to Customs. + Active engagement of pre and post shipment audit review , inclusive of valuation, classification, country of origin and applicable special program ... Conduct internal training specific to Customs operations. + Support active review and revisions of business policies, procedures and manuals associated with… more
- Trinity Health (Albany, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... is strongly preferred). Master's degree preferred. Certification (CPHRM) is preferred. Registered Nurse preferred. Ideally, the candidate will have 3-5 years in risk… more