- 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
- 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
- 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
- Stony Brook University (Stony Brook, NY)
- …regulatory agency mandates which ICD-10 CM billing codes, medical necessity and medicare questionnaires. + Will handle all processing of biological specimens in the ... 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
- Kelly Services (Rochester, NY)
- …Description** The Pharmacy Prior Authorization Technician performs initial-level processing and review of prior authorization requests for both pharmacy and medical ... directed + Issue verbal and written notifications to members as required + Review and interpret prescription and medical benefit coverage (including Medicare D);… more
- St. Mary's Healthcare (Amsterdam, NY)
- …educate insurance teams. . Collaborate with the Senior Claims Analyst to review issues, adjust workflows, and reduce unnecessary workloads. . Confirm insurance ... services provided and inform patients and/or practitioners of any non-authorized services. . Review , monitor and bill Episode of Care claims for our Managed Care… more
- HCR Home Care (Plattsburgh, NY)
- …software. Notify staff, as appropriate, to ensure proper coordination of care. + Review and approve all interim orders before they are sent to physician. Notify ... Report when the MRS is unable to retrieve the unsigned order. + Review and follow-up on entitlement verification issues. + Verify/Ensure there are orders for… more
- Fresenius Medical Center (Centereach, NY)
- …the designated clinical application accurately and in a timely manner. + Review treatment sheets for completeness ensure nursing signatures are documented and ensure ... appointments + Weigh patient and obtain vital signs + Collect treatment records and review for completion. Notify RN of incomplete / missing records. + Cleaning and… more
- HCR Home Care (Rochester, NY)
- …software. Notify staff , as appropriate , to ensure proper coordination of care. + Review and approve all interim orders before they are sent to physician. Notif y ... is unable to retrieve the unsigned order . + Review and follow-up on entitlement verification issues . +...- solve effectively . + Possess knowledge of the Medicare guidelines governing home health agencies . + Organized,… more
- Molina Healthcare (Rochester, NY)
- …care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU ... also entails producing audit reports for internal and external review . The position may also work with other internal...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more