- SUNY Upstate Medical University (Syracuse, NY)
- …and HCPCS codes. + Ensure compliance with current healthcare regulations and payer requirements. + Prepare and submit claims to insurance companies, following up ... on unpaid or denied claims. + Collaborate with healthcare providers to clarify diagnoses and obtain additional information. + Maintain patient confidentiality and adhere to HIPAA guidelines. + Hybrid work available: 1-2 work days from home and 3-4 work days in… more
- WMCHealth (West Nyack, NY)
- …management experience in ambulatory setting or health insurance and other payer entities preferred. Knowledge of national care management standards and community ... resources highly preferred. Education: Registered Nurse, Bachelor's degree preferred Licenses / Certifications : Current license as a Registered Nurse is required. About Us: Bon Secours Charity Medical Group Bon Secours Charity Medical Group, part of Bon… more
- Catholic Health Services (Melville, NY)
- …and other health team members to understand and help comply with payer /contract issues and appeal preparation. Maintains strict standards for patient confidentiality ... and patient related information in addition to security of electronic (computer) information; complies with department, hospital, Peer Review Organization (PRO) and New York State regulations and policies on confidentiality. Minimum Requirements and… more
- Nuvance Health (Fishkill, NY)
- …in care to improve practice-based performance on key metrics and to maximize payer program clinical quality bonus potential. 3. Follows up with patients who have ... orders and/or referrals placed but who have missed going for important wellness screenings, lab draws, and other medical care. 4. Uses motivational interviewing techniques and proactively acts as a patient advocate, responding with empathy and respect to… more
- Stony Brook University (East Setauket, NY)
- …New York Medicaid reimbursement methodologies. + Knowledge of third party payer reimbursement and managed care contracts. + Experience investigating, reviewing and ... following-up on rejected, and/or denied inpatient and outpatient hospital claims. + Knowledge of CPT, HCPCs and ICD-10 coding principles. + Experience with Cerner Invision and/or Cerner Millennium Patient Accounting. + Experience in Insurance Verification. +… more
- Rochester Regional Health (Rochester, NY)
- …as a team player. + Understanding of managed care, formularies, and payer policies. + Experience with Electronic Health Records (EHR) systems. EDUCATION: LICENSES ... / CERTIFICATIONS: PHYSICAL REQUIREMENTS: M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent… more
- Option Care Health (Albany, NY)
- …& growth, utilizing a stakeholder value-creation approach across patient, prescriber, payer , pharma companies, and people. + Responsible for ensuring compliance on ... a national basis with local and federal regulations, accreditation standards and corporate policies to help drive effectiveness and consistency in operations. Helps ensures patient safety and satisfaction through all operations. Observes legal and ethical… more
- Independent Health (Buffalo, NY)
- …required; healthcare operations experience preferred. + Experience with secondary payer process and procedures preferred. + Experience applying COB against ... NYS Rules and Regulations, NAIC Guidelines and CMS Guidelines preferred. + Solid verbal, written and interpersonal communication skills, with proven customer service skills. Customers can include, but are not limited to, a member, provider, attorney, employer… more
- Ankura (New York, NY)
- …+ Proficient in review of revenue cycle data including EOBs, 837/835 data, and payer denial information + Works with the Project Manager to analyze and understand ... client concerns and develop project work plans + Conducts independent review of medical records + Drafts clear and concise analyses of medical record review findings + Prepares clear and concise analyses of clinical and revenue cycle data including that from… more
- Evolent (Albany, NY)
- …around a shared product vision. They will work closely with healthcare payer executives, clinical experts, frontline staff, and internal stakeholders, while actively ... collaborating with data science teams to ensure AI models are effectively translated into impactful, user-facing product features. The ideal candidate will bring a deep passion for applying data-driven approaches to transform healthcare and operational… more