- Excellus BlueCross BlueShield (Buffalo, NY)
- …and PH care across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations staff to ensure an ... that other Behavioral Health medical directors reviewing pediatric cases review those cases in accordance with Company policies. +...without restrictions and free of sanctions from Medicaid or Medicare required. + Minimum of five (5) years of… more
- Bassett Healthcare (Herkimer, NY)
- …in accordance with facility policies and procedures. Completes all required Medicare documentation. Report nursing care information to other Nursing Supervisors and ... facility departments and community agencies. Maintain an effective communication system: Review critical incidents and discuss with Director of Nursing and other… more
- University of Rochester (Rochester, NY)
- …Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro) ... (probationary and annual) based on observation, questions, and quality review of work performed. + In the absence of...the account to a self-pay financial class after a review of previous efforts has not resulted in revenue… more
- WMCHealth (Valhalla, NY)
- …referrals made and include any updates or completions notes for all referrals + Review worklist for new referrals throughout the day to ensure timely response + ... the case manager and care coordinator, implement the discharge review program mandated by New York State Department of...preferred + Knowledge of regulatory agency standards; Centers for Medicare & Medicaid Services, and Det Norske Veritas (DNV)… more
- FlexStaff (Bronx, NY)
- …from hospital/ED within 5 days, reconcile medications, and coordinate follow-up. + Review medical history every 6 months, formulate diagnoses, and ensure accurate ... in clinical documentation improvement activities and provide feedback to staff. + Review symptoms, identify active diagnoses, and inform PCPs of potential care gaps.… more
- Cognizant (Albany, NY)
- …team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI ... UB/institutional (CMS-1450) and/or professional (CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage guidelines and regulations. + Must be able… more
- Elderwood (Buffalo, NY)
- …Days - 8:00am - 4:00pm #Talroo Responsibilities + Electronic billing of Medicare , Medicaid and Third Party Insurance pharmacy claims utilizing Framework LTC Pharmacy ... Prior Authorizations required from Third Party Insurance + Bill/Invoice Review + Medicaid Pending Status Review +...+ Bill/Invoice Review + Medicaid Pending Status Review + Medicaid claim rebilling + Updated Skilled Nursing… more
- Apicha Community Health Center (New York, NY)
- …are not limited to: + Purchasing and Payables Management: System Management - Review daily activity in the automated management system, ensure that system is ... + Accounting: Complete bank reconciliations in a timely and accurate manner, review outstanding checks and alert the Controller of any discrepancies + Program… more
- Trinity Health (Albany, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... as required by law. **_Specific Activities_** + Conducts case finding by daily review of reported events and other information retrieved from other sources (ie,… more
- New York State Civil Service (NY)
- …each assigned home weekly (minimally) to provide nursing oversight and complete review of items. * Interacts with primary, medical specialists, various clinical ... day program, IES, residential staff. * Annually for everyone in your caseload, completes: review of medical section ISP, medication audit (each home). * Keeps up to… more