- Adecco US, Inc. (New York, NY)
- …fast-paced role that demands a strong understanding of medical reimbursement, Medicare and commercial payers, and buy-and-bill or specialty pharmacy distribution ... Support (20%)** - Assist offices with claims, billing and coding, appeals , medical benefit interpretation, and co-pay or patient assistance programs. Coordinate… more
- Evolent (Albany, NY)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... 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
- Elderwood (Hamburg, NY)
- …to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by ... experience within the HMO Managed Care Insurance Companies + Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review. Managed Care… more
- Humana (Albany, NY)
- …revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices and ensure timely, equitable resolution of issues. ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Cardinal Health (Albany, NY)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …investigate and resolve rejections or denials promptly. + Prepare and submit appeals for denied claims, including documentation and provider narratives as needed. + ... Epic, or similar) is required. + Comprehensive knowledge of commercial, Medicare , Medicaid, and workers' comp billing procedures preferred. + Strong analytical… more
- Cardinal Health (Albany, NY)
- …industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint, ... with long- and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial plans while planning for various… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... interface with the Finance Office regarding pertinent insurance information, eg Medicare , Medicaid, Blue Cross, and Commercial Insurance. Performs other related… more
- University of Rochester (Rochester, NY)
- …follow-up to obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. ... and all audits. + Coordinates response and resolution to Medicaid and Medicare credit balances. + Requests insurance adjustments or retractions. + Reviews and… more
- New York State Civil Service (Albany, NY)
- …management and medical malpractice; health information technology; managed care; Medicare /Medicaid Conditions of Participation (CoPs) and Conditions for Coverage ... animal and human subjects research, and clinical trials); revenue cycle appeals ; scientific misconduct; research conflicts of interest; good laboratory practices,… more