- Centene Corporation (New York, NY)
- …healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the ... optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and… more
- FlexStaff (Chappaqua, NY)
- …NY. Qualifications: * Proven experience in physician medical billing, specifically with Medicare Part B and in-network Managed Care. * Familiarity with medical ... and appealing denied or incorrectly paid claims. * Payer Appeals : Prepare and submit payer appeals through...* Payer Appeals : Prepare and submit payer appeals through mail, phone, or online platforms. * Documentation:… more
- Cardinal Health (Albany, NY)
- …+ Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Cell/Gene therapy and/or Oncology experience, preferred +… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and ... Develops, conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of...without restrictions and free of sanctions from Medicaid or Medicare required. + Minimum of five (5) years of… more
- Trinity Health (Syracuse, NY)
- …data and ensure charges/coding are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State ... Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed. Educates… more
- Trinity Health (Syracuse, NY)
- …data and ensure charges/coding are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State ... Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed.Educates clinical… more
- Evolent (Albany, NY)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Ellis Medicine (Schenectady, NY)
- …plan. + Assists Case Manager with medication prior authorizations. + Provides Medicare Important Message to Medicare beneficiaries per CMS Conditions of ... chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of insurance authorizations and… more
- Evolent (Albany, NY)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . . No history of disciplinary or legal action… more
- Evolent (Albany, NY)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more