- Molina Healthcare (Rochester, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- New York State Civil Service (Rochester, NY)
- NY HELP Yes Agency Insurance Fund, State Title Registered Nurse 2 - Medical Care (NY HELPS) Occupational Category Health Care, Human/Social Services Salary ... City Rochester State NY Zip Code 14604 Duties Description Registered Nurse 2 ( Medical Care)...limited to:* Perform claimant outreach* Perform catastrophic and/or high-cost claims management* Review and process PARS for… more
- Molina Healthcare (Rochester, NY)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… more
- Molina Healthcare (Rochester, NY)
- …quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review , or equivalent combination of relevant ... validation tools and process improvements - ensuring that member medical claims are settled in a timely...education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Rochester, NY)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more