- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: In constant pursuit of improving quality outcomes for the Health Plan, this position exists to retrieve and abstract data from medical records based upon an ... established set of guidelines. In addition, the second level of this job is responsible for auditing the retrieval and abstraction results. This is a seasonal role in which employees work the months of January through April. The daily schedule is flexible… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department that support of the Health Plans operations ... which monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. This role interacts with internal and external partners and Regulatory agencies. This role monitors trends, bring forward… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members ... and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: The LTC Customer Service Representative resolves customer inquiries via telephone, mail, fax, and email concerning, but not limited to, policy benefits, ... claim payments, benefit reductions and billing. The LTC Customer Service Representative provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance customer satisfaction.… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare ... Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making and implementation of medical coding reviews and coding policies ... to ensure accurate diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following programs, including but not limited to: * Prospective medical record review of health plan providers * Retrospective… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Summary: This position is primarily responsible for the overall management of strategic and national accounts. This includes but is not limited to acting as a ... strategic advisor to support clients in the decision-making process relative to benefit design, financial impacts, member experience, and industry trends. This role will focus on account retention activities and could expand to include prospecting of new… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: This position supports the workflow of the Medical Services division. Depending on the specific tasks assigned, the Medical Services Coordination Specialist ... provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care Management. This position acts as a resource for staff regarding members' specific contract benefits, consistent with… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: Under the direction of the Manager of LTC Benefits, the LTC Benefits Planner (Personal Care Advisor) has the responsibility of evaluating and managing those ... Insureds that are accessing their benefits based on their need for long-term care services. This includes ongoing evaluation of the Insured's eligibility for benefits, appropriateness of the plan of care, coordination of other insurance policies/providers,… more
- Excellus BlueCross BlueShield (Utica, NY)
- …Summary: The Medical Record Retrieval Specialist I/II is responsible for the retrieval of medical records from various healthcare facilities. This is a seasonal role ... in which employees work the months of October through January. The daily schedule is flexible based upon supervisor approval though employees will be expected to work 30 - 40 hours per week. Essential Accountabilities: Level I * Accurately and efficiently… more