- Constructive Partnerships Unlimited (Staten Island, NY)
- …the code of business conduct, the NYS and federal false claims acts, whistleblower protections and mandatory reporting. Completes corporate compliance training ... at least annually. Fully cooperates in all corporate compliance investigations and reviews. more
- Molina Healthcare (Yonkers, NY)
- …care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial ... terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Rochester Regional Health (Rochester, NY)
- …Responsibilities will include basic knowledge of medical billing, medical claims processing and accounts receivable collections. The Medical collection specialist ... must have the Ability to learn and understand medical billing protocol and reimbursement issues, work within Meditech and Emdeon to identify denial trends as well as be responsible for locating and monitoring overdue third party accounts preventing write off.… more
- Molina Healthcare (Yonkers, NY)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Constructive Partnerships Unlimited (Staten Island, NY)
- …the code of business conduct, the NYS and federal false claims acts, whistleblower protections and mandatory reporting. Completes corporate compliance training ... at least annually. Fully cooperates in all corporate compliance investigations and reviews. MACHINES OPERATED: + Lifts + Transfers more
- Defense Health Agency (Fort Drum, NY)
- …for federal civilian healthcare providers as they are covered by the Federal Tort Claims Act (28 USC | 1346(b)) while acting within the scope of their employment. ... Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching… more
- CDPHP (Latham, NY)
- …health care delivery against established criteria required. + Understanding of coding/ claims processing is preferred. + Ability to communicate effectively with ... members with varying levels of education, health literacy and understanding. + Demonstrated ability to interact with provider, members to positively impact the quality of patient care required. + Proven customer service skills. + Foster teamwork as an attitude… more
- Philadelphia Insurance Companies (Melville, NY)
- …the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an ... Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life… more
- WTW (New York, NY)
- …day to day service issues and questions (eligibility, carrier coverage and claims issues, compliance, etc.) + Preparing for and facilitating client meetings (prepare ... agendas and materials, coordinate resources, etc.) + Contributing to benefit plan analysis, design, cost savings and funding strategies + Engaging subject matter experts to address client needs + Conducting review of client deliverables to ensure alignment to… more
- Molina Healthcare (NY)
- …affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable ... financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care… more
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