- BronxCare Health System (Bronx, NY)
- …claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. In-service staff on Insurance ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- BronxCare Health System (Bronx, NY)
- Job LocationsUS-NY-Bronx ID2025-5671 Category Administrative/Clerical Position Type Regular Full-Time Division Bronxcare Hospital Center - Concourse Shift Day Shift ... Department : Name Patient Financial Services (BHCS) more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay. This… more
- City of New York (New York, NY)
- …is provided to those who fail to meet requirements. Your Impact: The Risk Management Specialist will identify and address potential risk for fraud. The ... of HPD's Section 8 program rules. Responsibilities: The Risk Management Specialist will be responsible for the...forward with assistance, entering into repayment agreement or subsidy denial or termination based on the research conducted with… more
- Select Medical (West Orange, NJ)
- …- West Orange** A Select Medical Hospital West Orange, NJ **Prior Authorization Specialist / Payor Relations Specialist ( RN , LPN )** **Full-Time** **Onsite ... Responsibilities** Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals… more
- CUNY (New York, NY)
- Cybersecurity Engineer (IT Security Specialist 3) - Provisional **GENERAL DUTIES** This position encompasses professional and responsible technical consultative ... go tohttp://www.cuny.edu/about/administration/offices/hr/classified-civil-service/ccsjobs/and view the Job Description for **IT Security Specialist .** **CONTRACT TITLE** IT Security Specialist **FLSA**… more
- Mount Sinai Health System (New York, NY)
- …processes appeals. Posts denials in IDX on a timely basis. + Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on ... **Job Description** The Procedural Billing Specialist I is responsible for multiple components of...and outpatient diagnoses and procedures. + Meets with practice management , leadership and/or physicians on a scheduled basis to… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records ... not limited to utilization review, hospital reimbursement, clinical compliance, case management , and transitions of care, as outlined in the responsibilities below.… more
- Molina Healthcare (Yonkers, NY)
- …appeals to the next level for review. * Generates and mails denial letters. * Provides support for interdepartmental issues to help coordinate problem-solving ... education and experience. * Customer service experience. * Organizational and time management skills; ability to manage simultaneous projects and tasks to meet… more
- Molina Healthcare (Yonkers, NY)
- …reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + Identifies ... clinical guidelines and other appropriate criteria with medical directors on denial decisions. + Supplies criteria supporting all recommendations for denial… more
- Molina Healthcare (Yonkers, NY)
- …on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports ... be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/appeals. * Provides… more
- City of New York (New York, NY)
- …is responsible for the organization, direction and supervision of the Case Management , Case Establishment, and the Case Support units which facilitate eligibility ... (FIA) is recruiting for one (1) Administrative Job Opportunity Specialist NM I, to function as Benefit Access Center...ensuring that Agency's requirements are met for opening, reopening, denial , closing, change in case status and change in… more