- New York State Civil Service (Bronx, NY)
- …as health advisor to multi-disciplinary team; provide consultation/peer review to other physicians/clinicians; supervise nurse practitioner; actively participates ... eligibility for full and unconditional participation in the Medicaid and Medicare programs which must be maintained for continued employment. Failure to… more
- Evolent (Albany, NY)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Albany, NY)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- New York State Civil Service (Staten Island, NY)
- …to 836 regulations such as incident reports and investigations and incident review .* Achieve OASAS service level goals for overall occupancy, patient days, and ... audit and evaluation, third party reimbursement, and program reporting units.* Review and approve staffing patterns, requests and assignments per operational needs… more
- New York State Civil Service (Queens Village, NY)
- …enhancements to technical and clinical staff.* Analyzes, monitors, and oversees the review , maintenance, and use of health records for completeness and accuracy.* ... issues regarding diagnostic codes for laboratory agencies and Medicaid and Medicare reimbursements.* Prepares for, coordinates, and participates in regulatory agency… more
- Evolent (Albany, NY)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- The Institute for Family Health (New Paltz, NY)
- …Article 31, and Dental Rules and Regulations around the Medicaid and Medicare RESPONSIBILITIES: + Compile and maintain records, statistics and reports as necessary. ... new staff + Coordinate new hire initial training, shadowing, and evaluation + Review and distribute correspondence and follow up as needed + Monitor current status… more
- Evolent (Albany, NY)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Mount Sinai Health System (New York, NY)
- …equivalent credential required + Proficient in CPT, HCPCS, revenue codes, and Medicare billing regulations. + Advanced proficiency in Epic, especially in EAP ... Mount Sinai Hospital **Responsibilities** **New Charge Requests & Clinical Documentation Review :** + Review clinical documentation to validate appropriate charge… more
- Access: Supports For Living (Middletown, NY)
- …and insurance companies, including but not limited to daily procedure review , self-pay and co-payment processing, ensuring payments related to participant services ... of identified revenue cycle billing issues + Handling billing cycle review procedures for pre-processing (scrubbing) of weekly claims processing + Analyze,… more