- Evolent (Albany, NY)
- …as HIPAA, as well as healthcare systems and domains (FHIR/HL7, EMR/EHR, Claims , Members, Providers, Payors, etc.). + Experience with designing and implementing ... well-thought-out APIs in a service-oriented architecture. + Strong problem-solving, communication, and organizational skills. Ability to work effectively in a team-oriented environment. **To comply with HIPAA security standards (45 CFR sec. 164.308 (a) (3)),… more
- American Express (New York, NY)
- …partners to improve customer experience, deliver on business goals and enhance claims and servicing + For external partners, responsible for ensuring all strategic ... and operational deliverables are met + Project management of all critical workstreams to drive project plans forward toward targeted timeframes by ensuring oversight of critical timelines & progress of all activities + Lead identification of operational issues… more
- Air National Guard Units (Newburgh, NY)
- …must provide OFFICIAL transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof ... that you meet the Education requirements for this position. Additional Information If you are a male applicant who was born after 12/31/1959 and are required to register under the Military Selective Service Act, the Defense Authorization Act of 1986 requires… more
- Molina Healthcare (Albany, NY)
- …credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. * ... Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. * Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have… more
- Hartford Steam Boiler Inspection and Insurance Company (New York, NY)
- …enhancements and product strategies in collaboration with HSB's underwriting, claims and engineering units. Qualifications Education and Experience: + Bachelor's ... degree in Actuarial Science, Statistics, Economics, Finance, Mathematics, or related fields requiring modeling, programming, or quantitative analysis; alternatively, equivalent work experience. + Passed at least five (5) actuarial exams. + Four (4) or more… more
- Molina Healthcare (Rochester, NY)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts,… more
- CDPHP (Latham, NY)
- …information required. + Chronic Conditions knowledge preferred. + Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred. ... + Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required. + Experience with Clinical Documentation Improvement preferred. + Demonstrated knowledge of medical record review and diagnosis coding within the health insurance… more
- AECOM (New York, NY)
- …Work with management and staff to resolve pre-litigation disputes and potential claims + Supervise and manage litigation, including professional liability, breach of ... contract, and personal injury/wrongful death matters, utilizing outside counsel retained by the company to maximize quality and cost-effectiveness + Manage external counsel and litigation budgets + Handle subpoenas, document requests, and other litigation… more
- Cardinal Health (Albany, NY)
- …patient medical records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise EMRs, the registration process ... and charge entry. + Supports the overall workplan of the Compliance Department. + Other duties as assigned. **_Qualifications_** + 8-12 years of experience, preferred + Bachelor's degree in related field, or equivalent work experience, preferred* Bachelor's… more
- The Walt Disney Company (New York, NY)
- …and/or witness testimony. + Researching and resolving copyright and other claims and/or other inquiries regarding news materials, as necessary. + Providing ... vacation coverage for other lawyers in the group, which may involve working on nights or weekends. + Interpreting existing group and ABC News policies and supporting the objectives articulated by higher level lawyers in the group and the Disney Legal… more