- Excellus BlueCross BlueShield (Rochester, NY)
- …for the following programs, including but not limited to: * Prospective medical record review of health plan providers * Retrospective medical record review of ... were correctly reimbursed and documented. Reports findings of the data validation review . Prepares and submits adjustments to the appropriate processing / adjustment… more
- 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 ... cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and… more
- New York State Civil Service (Thiells, NY)
- …determination of a person meeting the criteria for OPWDD services as well as the review and completion of the Level of Care form allowing individuals to enroll into ... are essential in addressing the following work activities:* Complete a clinical review of eligibility documentation comprised of testing and assessments* Assist with… more
- New York State Civil Service (Queens Village, NY)
- …development of patient goals and programming to meet the needs of patients.* Review policies and procedures with staff.* Review rehabilitation programs available ... with the Treatment Team Leader in policy meetings, long-term program planning, and review meetings to update, improve, and maintain programs which meet client needs… more
- Bassett Healthcare (Oneonta, NY)
- …of Advanced Beneficiary Notice signatures and form processing to meet Medicare regulations. Ensures all corrections (demographics, insurance eligibility etc.) based ... from providers or other staff to adjust appointment schedules to Supervisor for review and approval before acting, as noted by Supervisor. Reviews the electronic… more
- Stony Brook University (Stony Brook, NY)
- …for submission to the Department of Veteran's Affairs. + Completes notification to Medicare beneficiaries for changes in level of care (SNF ABN, NOMNC). + Completes ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Stony Brook University (East Setauket, NY)
- …+ Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge of third ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Stony Brook University (East Setauket, NY)
- …Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge of ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Stony Brook University (East Setauket, NY)
- …hospital Managed Care payment variances and denials. + Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies. + Expert ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… 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 ... payer regulations. Performs coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review Responsible for proofing daily… more