- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for defined geography and promptly… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... agencies. + Identify issues and patterns with claims and insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the supervisor… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social workers for ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home care, payer, or… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... collection agencies. + Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the… more
- Elevance Health (East Syracuse, NY)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more
- Molina Healthcare (Buffalo, NY)
- …needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings ... processes and established guidelines; provides appropriate follow up on peer review findings + Identifies, defines and communicates opportunities for improvement to… more
- Independent Health (Buffalo, NY)
- …Independent Health policies, summary plan descriptions, member contracts, and Centers for Medicare and Medicaid Services (CMS) guidelines for all lines of business. ... managers, attorneys, other insurance companies, regulatory agencies (ie Centers of Medicare and Medicaid) and internal departments effectively. + Identify and… more
- 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
- 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