- Stony Brook University (Stony Brook, NY)
- …may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...Documents over utilization of resources and services. + All Medicare cases are reviewed for level of care on… more
- Stony Brook University (Stony Brook, NY)
- …Assistant** **may include the following but are not limited to:** + Billing for Medicare (Part A & B), Medicaid, Private, Insurance, NAMI, Physician , and Adult ... the Attorney General's office. + Monitor all Medicaid remittances, review any case denied, and rebill if necessary or...system and monthly closing functions. + Enroll residents in Medicare Part D plans. + Oversee all banking for… more
- Stony Brook University (Commack, NY)
- …and direct the negotiation, execution, and administration of all hospital, physician , and ancillary Managed Care contracts. + Maintain accurate, up-to-date Managed ... Care contract databases and tracking tools. + Timely review contract terms and upon renewal draft necessary language revisions to protect the organization's… 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 ... other staff to adjust appointment schedules to Supervisor for review and approval before acting, as noted by Supervisor....or films related to appointment are available for the physician at the time of the appointment using available… more
- HCR Home Care (Rochester, NY)
- …and assess for normality . Review new lab order via fax and email clinician to review and n otify case manager and physician , as appropriate . + En try of ... or advising on patient care questions or concerns. + Review and approve all new interim orders before they...all new interim orders before they are sent to physician . Notify Clinical Manager/Regional Director if unable to approve… more
- Northwell Health (Staten Island, NY)
- …157934 Job Description Serves as liaison between the patient and facility/ physician . Ensures a continuum of quality patient care throughout hospitalization and ... of Social Work Services and makes referrals when appropriate. + Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow. + *… more
- Molina Healthcare (Albany, NY)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Evolent (Albany, NY)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve ... as the Physician match reviewer in Imaging cases, that do not...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** . Serve ... as the Physician match reviewer in Advanced Imaging cases, that do...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Trinity Health (Syracuse, NY)
- …in surgical or specialty coding practice. Reviews chart, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to ... data and ensure charges/coding are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State… more