- Highmark Health (Buffalo, NY)
- …and key internal/external stake holders to provide the most appropriate support for providers with gain/risk share contracts. **ESSENTIAL RESPONSIBILITIES** + ... and interpretation of quality and efficiency reports; When relevant, dissemination and support of gap closures for STARS and improved coding for government… more
- City of New York (New York, NY)
- …Client Services Unit is responsible for the agency's benefits and support services, this includes ongoing resource development, policy and programmatic improvements ... also be a subject matter expert in processing VA claims for Veteran benefits and supervising staff on how...reporting requirements for client services and related veteran data. Support Outreach and Engagement efforts: Maintain key relationships in… more
- MetLife (Oriskany, NY)
- …life claims to identify claim situations requiring referral to Complex Case Manager Specialist or Claims Quality Specialist . . Maintain good rapport with ... FEGLI Life claims to make claim determinations. . Provide UAT support for system enhancements. Typical Qualification and Key Competencies: . Ability to adjust… more
- Molina Healthcare (Albany, NY)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and overpayment recovery which improves encounter submissions, reduces General and Administrative expenses (G&A) costs, and continues to drive positive operational… more
- MVP Health Care (Schenectady, NY)
- …+ Champion Lean and Six Sigma methodologies to streamline workflows and reduce administrative costs. + Improve first-pass claims accuracy and reduce provider ... Integrity & Cost Containment** to lead enterprise-wide initiatives that ensure claims are paid accurately, ethically, and efficiently. This high-impact role… more
- Molina Healthcare (Yonkers, NY)
- **Job Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- New York State Civil Service (Endicott, NY)
- …70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Claims Service Representative 1, Claims ... Title Policyholder Services Representative 1/Trainee 1/2 (NY HELPS) Occupational Category Administrative or General Management Salary Grade NS Bargaining Unit PS&T -… more
- New York State Civil Service (Buffalo, NY)
- …of Civil Service Law. Eligible titles include, but are not limited to: Administrative Assistant 1, Business Document Specialist 2, Motor Vehicle Consumer ... Clerical, Secretarial, Office Aide Salary Grade 13 Bargaining Unit ASU - Administrative Services Unit (CSEA) Salary Range From $53413 to $65061 Annually Employment… more
- City of New York (New York, NY)
- …TITLE. THIS IS A PROVISIONAL APPOINTMENT, WHEN A TEST BECOMES AVAILABLE IN THE ADMINISTRATIVE JOB OPPORTUNITY SPECIALIST (ADMIN. JOS) TITLE, YOU MUST TAKE AND ... YOU MUST BE PERMANENT IN THE ASSOCIATE BENEFITS OPPORTUNITY SPECIALIST TITLE FOR AT LEAST ONE YEAR OR PERMANENT...Outreach, Rehousing and Landlord program is recruiting one (1) Administrative JOS (NM) I to function as the Deputy… more
- Molina Healthcare (Albany, NY)
- …in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support , or other specific program ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more