- University of Rochester (Rochester, NY)
- …working claim activity in EPIC + Works in assigned EPIC follow up workqueue(s). + Review reason for claim denial - reason code or denial codes in EPIC. + View ... Payer Website link (EPIC Insurance Coverage tab), review payer website, or contact payer representative as to...audits + Coordinate responses and resolution to Medicaid and Medicare credit balances. + Request insurance adjustments or retractions.… more
- Stony Brook University (Ronkonkoma, NY)
- …Finally, the Contract Officer III may have extensive interactions with SUNY Counsel in the review of contracts that must be sent to the Office of the NYS Attorney ... or other State or Federal (HIPAA or Medicaid / Medicare investigations) and auditors as requested. + The individual...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- CenterWell (Hauppauge, NY)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and...documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and… more
- Stony Brook University (Commack, NY)
- …accurate, up-to-date Managed Care contract databases and tracking tools. + Timely review contract terms and upon renewal draft necessary language revisions to ... settlement discussions, and reimbursement escalations. + Ensure compliance with Medicare and Medicaid reimbursement methodologies and stay current on...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- Saratoga Hospital (Saratoga Springs, NY)
- …federal and accreditation requirements, including but not limited to the Centers for Medicare and Medicaid (CMS) and the Joint Commission (JC), DNV, OSHA, CMS and ... survey coordination, offsite mock surveys, unannounced surveys and assists with the review of regulatory standard crosswalks for every dept. in the organization as… more
- Bassett Healthcare (Cooperstown, 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
- 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
- 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
- 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