- Humana (Albany, NY)
- …us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- CenterWell (Albany, NY)
- …and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS… more
- Molina Healthcare (Buffalo, NY)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive… more
- Mohawk Valley Health System (Utica, NY)
- …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals .… more
- The Wesley Community (Saratoga Springs, NY)
- …and x ray vendors receive required resident information for services. + HMO and Medicare appeals management. + For medical records requests follow medical record ... release policy. Gather and organize mailings, track dates and maintain a log of requests. + Ensures unit secretaries manage resident appointments to include all required steps in process following the "appointment procedure" to include transportation. +… more
- Elevance Health (East Syracuse, NY)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Molina Healthcare (Syracuse, NY)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …of the electronic payment application for Medicare + Help complete any Medicare audits, medical records requests, and appeals and monitor the outcomes. + ... **Job Summary:** Assist in billing and cash application of Medicaid/ Medicare /DME/Home Infusion claims. Manage open accounts receivable which requires rebilling… more
- Humana (Albany, NY)
- …and/or requested site of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of regulatory compliance, and work ... teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid, and Medicare Advantage requirements and will understand… more
- Lifespan (Rochester, NY)
- …daily operations. Recruiting, training and supporting volunteer counselors who help Medicare beneficiaries understand their complex health insurance (Parts A, B, C, ... volunteer time. Scheduling community events, ie, tabling events, health fairs and Medicare presentations in the community. We help individuals with Medicare … more