- Finger Lakes Community Health (Sodus, NY)
- …+ Follow-up on referral progress for patients initiated by provider + Review patient information during pre-visit planning to ensure appointments are appropriately ... immunizations as directed by ordering provider + Complete medication reconciliation + Review and send medication refill requests to patient's provider + Inform… more
- City of New York (New York, NY)
- …the Office of Medicaid Inspector General (OMIG), provider organizations (hospitals, physician groups and pharmacies), city agencies, client advocates, and MAXIMUS ... pace with these changes to ensure continued services to its consumers. Also review progress and performance reports submitted by the senior and supervisory staff for… more
- Elderwood (Williamsville, NY)
- …care staff. + Evaluate resident on admission, obtain medical history, check physician orders, transfer and pre-admission information. Review resident's medical ... nursing representative for Department of Health matters. + Conduct assessments, review medical histories, and guide care planning from admission through discharge.… more
- Kaleida Health (Buffalo, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data.The CDS facilitates obtaining ... of the health care team. The CDS is also responsible for audit review to identify potential documentation deficiencies in specific records and to identify clinical… more
- Molina Healthcare (Albany, NY)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... Improvement activities. + Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends… more
- WMCHealth (Kingston, NY)
- …as required. + Brings all opportunities for program improvement noted from data review to the attention of the program director in a timely, appropriate manner. ... + Refers any repetitive physician /resident clinical or documentation outliers to the stroke program...clinical or documentation outliers to the stroke program peer review process. + Participates in outreach and community education… more
- University of Rochester (Rochester, NY)
- …of the patient and clinical risk assessment, collateral information and review of current/percent history of clinical presentations/services. The clinical evaluator ... guardian, during the course of the evaluation in collaboration with the CPEP physician and CPEP Nursing staff. The Clinical Evaluator documents their evaluation and… more
- University of Rochester (Albany, NY)
- …billing system necessary to ensure balance resolution for all assigned URMFG physician services. + 25% Follows up on multi-faceted denials through review ... and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. + 5% Collaborates with Claim Edit Specialists and Patient… more
- CDPHP (Latham, NY)
- …for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality ... diploma or GED required. + Minimum of (1) year claims examining procedural review experience utilizing CPT-4, HCPCS, and ICD-9 codes is highly preferred. +… more
- Datavant (Albany, NY)
- …Knowledge of healthcare industry, payment models, risk adjustment, medical coding, physician workflow, and/or electronic health record systems + Advanced Excel ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more