- Molina Healthcare (Rochester, NY)
- …recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. ... and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. +… more
- Trinity Health (Albany, NY)
- …and regularly evaluated on competencies and quality of work. + Leads oversight of appeals denied claims for elated services, drugs, treatments and supplies. + ... authorizations. + Facilitates communication with care team and providers + Appeals denied authorizations for related services, drugs, treatments, and supplies. +… more
- US Physical Therapy (Uniondale, NY)
- …for career growth in revenue cycle management! **What You'll Do** + Manage commercial insurance claims from submission through payment + Follow up on denials, ... rejections, and appeals to ensure reimbursement + Communicate with ...collection processes **Qualifications** + 2+ years of experience in medical billing/ claims management + Familiarity with CPT,… more
- Crouse Hospital (Syracuse, NY)
- …+ Strong knowledge of MS Office. + Good working knowledge of all major medical insurance programs and electronic patient account computer systems. + Must have ... and hard copy Remittance Advices. + Timely submission of appeals on denied claims , and works payers'...will be administered by Human Resources. Benefits Overview: + Medical , Dental, Vision, FSA, and 401K. + Company paid… more
- Catholic Health Services (Melville, NY)
- …and resubmits claims , as required. + Verifies accuracy of patient insurance and demographic information. + Generates bills to patients for services not covered ... primary and secondary billing, submits hard copy or electronic claims to appropriate payors. + Reviews and edits any...by insurance . + Investigates duplicate payments and takes appropriate action… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …+ Follow up is to be done bi-monthly on assigned controls to include corrected claims , appeals , phone calls, or provider rep assistance to assure any missing or ... charge amounts, etc to assure accuracy before sending to insurance payer. + Sends reviewed superbills via electronic or...flow for organization. + Checks clearinghouse, Availity, for any claims in error edits, corrects, and submits to payer… more
- Highmark Health (Albany, NY)
- …medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary ... through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. +… more
- UIC Government Services and the Bowhead Family of Companies (New York, NY)
- …of Defense and many federal agencies. Bowhead offers competitive benefits including medical , dental, vision, life insurance , accidental death and dismemberment, ... DHS in appellate proceedings before the Board of Immigration Appeals , and providing support and direction to the Department...characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq.,… more
- University of Rochester (Rochester, NY)
- …edits and obtains signatures for non-routine letters of correspondence related to appeals on denied claims . This includes compiling all necessary information ... invited lectures and speaking engagements for the provider. - Researches hospital medical records for information requested by physicians, insurance companies… more
- New York State Civil Service (New York, NY)
- …including rates of medical necessity approvals and denials, rates of appeals , claims paid; and cost-sharing requirements;* Reviews the health care provider ... Bureau. Duties include, but are not limited to, the following:* Reviews health insurance programs and health care reform initiatives in relation to mental health and… more