- Cedars-Sinai (Beverly Hills, CA)
- …care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
- City of New York (New York, NY)
- …schools across New York City. OSH provides NYC Health Code-mandated clinical services, public health initiatives, chronic disease management, reproductive health ... services. - Attend to the health needs of designated school community. - Provide direct clinical services to an assigned panel of schools. - Serve as a consultant to… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …initiatives in collaboration with the Director of Operations, Quality Improvement Specialist , and Utilization Management. The role involves providing support and ... consultation for utilization management (medical and pharmacy), appeals , medical policy (development and maintenance), and quality improvement (Medicare Stars,… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …Excelsior Orthopaedic Physicians for completeness and to abstract and code clinical data, using standard classification systems. Duties and Responsibilities + ... payer-specific requirements, and company policies. + Communicate with providers and clinical staff to ensure accurate documentation to produce accurate coding. +… more
- Community Health Systems (Franklin, TN)
- …authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software ... and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and … more
- Mount Sinai Health System (New York, NY)
- …provider data management that will feed or interface with all applicable clinical and administrative enterprise systems, centralize all provider performance data and ... _Director, Medical Affairs Operations_ will play a pivotal role in a dynamic, clinical /operational environment by serving as the point person in the management of… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …payer-specific requirements, and company policies. + Communicate with providers and clinical staff to ensure accurate documentation to produce accurate coding. + ... Monitor coding edits, denials, and rejections; assist in appeals and corrections as needed. + Collaborate with the billing team to resolve coding and reimbursement… more
- The County of Los Angeles (Los Angeles, CA)
- …in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the ... disaster/emergency services, when required. Regional Disaster Medical and Health Specialist Program (RDMHS) Assists in the development, implementation, and… more
- Rochester Regional Health (Rochester, NY)
- …the medical management department in the tracking, trending and reporting of appeals and charge recovery information. + Conducts reviews of cost outliers and ... Provides ongoing support for the tracking and trending of the Reimbursement Specialist charge recovery activities. + Assists with special projects including but not… more
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