- Raphael and Associates (New York, NY)
- …Adjuster to apply their knowledge of negligence theories while investigating Liability claims . This position provides an opportunity for the right candidate to ... : + End to end management of liability field claims according to client guidelines and state requirements. +...to provide superior reports so that proper evaluations of claim values can be made. + Appropriately represent the… more
- Molina Healthcare (Buffalo, NY)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and...that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
- GE Vernova (Schenectady, NY)
- …and other EPC claims + Research, pursue, negotiate and obtain insurance claim recoveries + Drive Supplier recovery working in conjunction with Sourcing + Ensure ... commercial expert in preventing and mitigating high dollar value claims and risks. In this role, you will: +...and implement risk mitigation strategies + Research and author claims settlement agreements + Manage and drive Contract Change… more
- Sedgwick (Albany, NY)
- …& Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims regionally unassisted up to $10M, including having the ability to address ... and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. +… more
- Albany Medical Center (Albany, NY)
- …per policy on a daily basis Validate timely follow up on all outstanding claims Validate timely submission of all payor appeals for claim denied erroneously ... Ensure that staff are trained on payor contracts Ensure claims are paid per contract terms Ensure that all...all third party payor and federal and state government claim submission regulation Monthly review of chargemaster CPT, HCPCS… more
- Guidehouse (New York, NY)
- …of assigned Medicare and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. ... needed + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific...Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, review… more
- City of New York (New York, NY)
- …medical records requests from MCO to obtain prior authorization approvals and claim reimbursement. - Review all claims CPT/ICD-10/HCPCS, payment modifiers in ... perform health insurance billing activities and support functions including claim review, claim submission, follow up and...denials in a timely manner. - Prepare and batch claims out to third party payers for reimbursements. -… more
- Tutor Perini (New Rochelle, NY)
- …all changes from initiation through negotiation and final approval. + Investigate potential claims , such as delays, unforeseen conditions, or extra work. + Prepare ... claim documentation including narratives, cost breakdowns, time impact analyses...+ Collaborate with legal and contract teams to ensure claims are submitted in accordance with contract terms and… more
- Access: Supports For Living (Middletown, NY)
- …revenue management throughout the revenue cycle. This individual manages the electronic claims process, including accurate and timely claim batch creation, ... issues + Handling billing cycle review procedures for pre-processing (scrubbing) of weekly claims processing + Analyze, billing and processing program claims for… more