- Catholic Health (Buffalo, NY)
- …8-4 with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for ... include setting up arbitration between parties. This individual provides clinical oversight to the clinical denials... areas and third-party payers in scenarios related to denials and appeals . This position educates all… more
- Cognizant (Albany, NY)
- …advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process ... well as timely filing deadlines and processes. . Review clinical denials including but not limited to...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and ... appeals functions to include coordination of specific process and...accurate utilization data in a timely fashion. + Monitors denials as well as all financial metrics associated with… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and ... practitioner issues. manages client denials and concerns by conducting a comprehensive analytic review...and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an appeal or further… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… 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 at/in Garnet... Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- Mount Sinai Health System (New York, NY)
- … Clinical /Technical/Service** + Demonstrates the ability to perform clinical /technical/service/administrative tasks: + Prioritizes Insurance Requests / Denials ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements...Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical Record requests for… more
- Baylor Scott & White Health (Albany, NY)
- …processes. + Identifies denial trends and leads initiatives to reduce preventable clinical denials . + Develops and presents performance dashboards and reports ... Liaisons and Collectors focused on appealing hospital and professional clinical and coding denials , as well as...and other revenue cycle departments to streamline referral and appeals workflows. + Supports education and training initiatives to… more
- Mount Sinai Health System (New York, NY)
- …AR trends and billing lags. + Collaborate with department such as coding, IT, clinical service areas and appeals to ensure seamless end-to-end revenue cycle ... days in Accounts Receivable, increasing cash collections, reducing bad debt decreasing denials and eliminating write offs due to process issues. + Ensures workflows… more
- Mohawk Valley Health System (Utica, NY)
- …potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals ... utilization of resources. The Physician Advisor guides the team to improve clinical and financial outcomes with documentation and clinical education. Core… more
- Bassett Healthcare (Cooperstown, NY)
- …reporting of resources and financial indicators including LOS, excess days, resource utilization, denials and appeals , swing bed statistics. + Uses data to drive ... facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and… more
- Mount Sinai Health System (New York, NY)
- …facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials . ... Case Management FT Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …and recover outstanding receivables. Identify trends in payments, underpayment/overpayments and denials . Work with respective departments to evaluate trends and be ... the revenue cycle processes. Directly manage and resolve all assigned underpayment appeals , follow-up and payer relationships. Report to management any gross payment… more
- Rochester Regional Health (Rochester, NY)
- …Sign-On Bonus: SUMMARY: Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by ... sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately...phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed… more
- Mount Sinai Health System (Long Island City, NY)
- …will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process ... **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or a related… more
- New York State Civil Service (Queens Village, NY)
- …and assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... management, development, and oversight of services.* Providing full range of clinical and administrative supervision to subordinate staff; may act as shift… more
- Highmark Health (Albany, NY)
- …workflow within the department. + Prioritize requests for drug authorizations or denials . + Review of prior authorization criteria for drug products. + Recommend ... obtain necessary and/or additional information when necessary. + Consult with staff clinical pharmacist for guidance and assistance as necessary. + Document all… more
- Ellis Medicine (Schenectady, NY)
- …MIDAS per policy. + Prints/copies the chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data ... information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager...entry of insurance authorizations and denials . + Denial Management Activities + Assists Denial Management… more
- Amgen (New York, NY)
- …supporting the entire reimbursement journey through payer prior authorization to appeals / denials requirements and forms + Review patient-specific information in ... private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales + Strong medical reimbursement experience and/or… more