- 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
- New York State Civil Service (Brooklyn, NY)
- …physical ability, and/or rehabilitative and clinical needs of individuals. * Review and evaluate program effectiveness and recommending program changes or ... specialized activities as needed.* Attend and participate in treatment plan review sessions providing input as relates to the program participants participation in… more
- Healthfirst (NY)
- …updates to payment methodologies, fee schedules and claims editing policies from Medicare , Medicaid, and third-party sources. + Responsible for the overall success ... to existing claims configuration audits and claim reporting functions. + Review technical specifications to ensure the Claims Configuration Department business… more
- New York State Civil Service (Orangeburg, NY)
- …Serve as health advisor to multi-disciplinary team; provide consultation/peer review to other physicians/clinicians; supervise nurse practitioners and/or physician ... 6. Act as a participating member of the Management Team, Incident Review Committee and Health and safety Committee.7. Provides clinical supervision, guidance, and… more
- Healthfirst (NY)
- …faxes, and any additional information required to complete the audit. + Review and investigate appeals and grievances requests to ensure all requests are ... identified, classified, and fully resolved in a compliant manner. + Review clinical documentation for accuracy, completeness identifying any discrepancies or… more
- WMCHealth (Valhalla, NY)
- …requests for specialty medications, tracking expiring authorizations and renewals + Review claims and rejections to determine required follow-up, ensuring timely ... & Quality Assurance: + Ensure all activities are compliant with HIPAA, Medicare /Medicaid billing regulations, and the 340B Drug Pricing Program + Participate in… more
- Planned Parenthood of Greater New York (Schenectady, NY)
- …Workqueue. . Confirm scheduled appointments using the Epic Confirm Worklist. . Review payer information and verify insurance details. . Inform patients of financial ... tasks for procedure visits, including initiating prior authorization processes. . Review payer information and verify insurance details. . Inform patients of… more
- Mohawk Valley Health System (Utica, NY)
- …barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, ... appropriateness of admission and continued stay, severity, and morbidity/mortality. + Review patient status when admission criteria is non-sufficient for admission.… more
- New York State Civil Service (Brooklyn, NY)
- …may include, but are not limited to:* Interview clients and review medical/psychiatric history, and complete various assessments as part of treatment ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain Medicaid/ Medicare eligibility will result… more
- Elevance Health (New York, NY)
- …in medication use quality improvement programs, analyzing pharmacy spend and trends, and Medicare Star Part D measures strongly desired. + Experience working with ... Medicare and Commercial providers strongly preferred. + PBM or...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
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