- 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
- 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
- Performance Optimal Health (Stamford, CT)
- …through exceptional care, service, and teamwork. We are seeking a Billing Specialist to join our growing Practice Administration/Billing team. This role combines all ... authorizations/pre-certifications as required by payers. + Resolve billing issues, denials , and underpayments by following up with insurance companies, patients,… more