- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Intermountain Health (Albany, NY)
- **Job Description:** The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance ... true reason of the denial and review payer contracts, clinical data and other data to be able to...**Preferred** + Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role. +… more
- Mount Sinai Health System (New York, NY)
- …facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials . ... **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position...Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …clarify documentation and ensure code accuracy. + Monitor and respond to coding-related denials , rejections, and edits; assist with appeals and identify areas ... CPT, ICD-10-CM, and HCPCS Level II codes for surgical and clinical procedures, ensuring accurate reimbursement, coding compliance, and efficient billing processes.… more
- Garnet Health (Middletown, NY)
- …responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team... Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- Mohawk Valley Health System (Utica, NY)
- …+ Provide guidance and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. ... potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals… more
- University of Rochester (Rochester, NY)
- …**Responsibilities:** Serves as the patient referral and prior authorization specialist , with oversight of data and compliance to enterprise standards ... referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non- clinical staff, identifying barriers to appointment… more
- University of Rochester (Rochester, NY)
- …referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non- clinical staff, identifying barriers to appointment ... company barriers and tracking all assistance provided. Accountable for planning, execution, appeals and efficient follow through on all aspects of the process which… more