- Elevance Health (Latham, NY)
- …make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...audit activities. + Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and… more
- Elevance Health (Latham, NY)
- Nurse Audit Lead - Carelon Payment Integrity **Location:** The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a ... is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- New York State Civil Service (Menands, NY)
- NY HELP Yes Agency Workers' Compensation Board Title Registered Nurse 2 (Medical Care) (NY HELPS), WCB Item #2346 Occupational Category Health Care, Human/Social ... allowed? Yes County Albany Street Address Medical Director's Office, Clinical Standards Unit 150 Broadway City Menands State NY...a current license and registration as a registered professional nurse in New York State and two years of… more
- St. Mary's Healthcare (Amsterdam, NY)
- …based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items ... drafting appeals, negotiating with payers, or following up with payer utilization review departments in attempts of obtaining authorizations and claim payment. *… more
- CDPHP (Albany, NY)
- …Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations ... these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance… more
- Bassett Healthcare (Delanson, NY)
- …up emergent situations or expressed patient problems directly to Supervisor or Supervising Nurse for assistance as observed by Supervisor and Supervising Nurse ... regarding the organization and/or services, and provides directions to the appropriate clinical location as necessary. Offers patients the opportunity to sign up for… more