- Evolent (Albany, NY)
- …Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals. + Other duties as assigned. **Qualifications Required ... and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- **Required** + Able to work in a rotation to… more
- City of New York (New York, NY)
- …management functions within two (2) juvenile detention facilities for youth pending adjudication of court proceedings. - Supervise and coach two (2) Directors of ... Case Management responsible for daily supervision and direction of case management activities in the juvenile detention facilities and provide coverage in the absence of the directors as needed. - Actively participate in the development, coordination, and… more
- Sedgwick (New York, NY)
- …of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific ... client service requirements. **ESSENTIAL RESPONSIBILITIES** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. +… more
- University of Rochester (Rochester, NY)
- …resolution. + Contacts payers on incorrectly paid claims completing resolution and adjudication . + Adjusts accounts or processes insurance refund credits. + Reviews ... and advises leadership on incorrectly paid claims from specific payers. + Works with leadership on communication to payer representatives regarding payment trends and issues. + Bills primary and secondary claims to insurance. + Identifies and clarifies billing… more
- CVS Health (Albany, NY)
- …highly skilled and experienced Senior Product Owner to join our Commercial Claim Adjudication engineering team. As a Senior Product Owner, you will contribute to ... product strategy by: + Leading the development and enhancement of Commercial Claim products or services. + Conducting market research. + Collaborating with cross-functional teams and considering the end-to-end perspective of all impacted areas. + Designing… more
- CVS Health (Albany, NY)
- …seeking a highly skilled and experienced Engineer to join our Commercial Claim Adjudication team. As a Release Manager, you will contribute to product strategy by: ... + Leading multiple Agile teams to estimate, design, code, and implement solutions and systems by applying advanced technical expertise to architect and code software applications. + Managing resource availability, team capacity, and allocations for multiple… more
- Mount Sinai Health System (New York, NY)
- …models. ? Experience in working with insurance plans and understanding of claim adjudication processes. Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount ... Sinai Hospital **Responsibilities** 1. Track and Trend Compliance Issues: * Monitor contract terms and conditions for adherence across all claims, identifying patterns of non-compliance. * Conduct trend analysis and provide data-driven insights into recurring… more
- New York State Civil Service (Brooklyn, NY)
- …representation issues or as an employer or union advocate in the adjudication and resolution of such labor-management disputes. Additional Comments This position is ... located in Brooklyn, NY. Incumbents may be allowed to work up to 50% remote, depending on work demands and after initial training. Location pay for employees at this location is $4,000 annually. Candidates under consideration will be required to attend an… more
- Datavant (Albany, NY)
- …on payer policy changes, CMS updates, and healthcare regulations affecting claim adjudication . **What you will bring to the table:** + Associate's or Bachelor's ... degree in Health Information Management, Health Administration, or related field required. + RHIT, RHIA, CCS, or CPC certification preferred. + Minimum 3-5 years of experience in healthcare revenue cycle with focus on denials management. + Strong knowledge of… more
- CVS Health (Albany, NY)
- …Experience implementing template and/or customized clinical programs. + Knowledge of PBM adjudication engine and other systems leveraged in support of clients. + ... AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement. **Education** Bachelor of Science Pharmacy or PharmD. Active, unrestricted pharmacist licensure required **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay… more