- Molina Healthcare (Buffalo, NY)
- …+ Experience independently reviewing and processing simple to moderately complex High dollar claims and knowledge of all claim types of reimbursements not ... such Stoploss, DRG, APC, RBRVS, FFS applicable for HD Inpatient, Outpatient and Professional claims . + 2+ years of comprehensive claim audits as preference +… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …experience Preferred : Type of Experience Required: 2+ years of claim processing experience with a Medicaid/Medicare Health Plan. Preferred : Experience ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Humana (Albany, NY)
- …Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… more
- New York State Civil Service (Pearl River, NY)
- …HELP No Agency Attorney General, Office of the Title Forensic Auditor : Investigate Complex Healthcare Fraud, 6405 Occupational Category Financial, Accounting, ... Medicaid Fraud Control Unit - Pearl River (Rockland County)Forensic Accountant/ Auditor Reference No. MFCU_PR_FAA_6405Application Deadline is October 31, 2025Salary… more
- Elevance Health (Latham, NY)
- **Performance Quality Auditor I** **Location:** _Virtual:_ This role enables associate to work virtually full-time, with the exception of required in-person training ... is granted as required by law. The **Performance Quality Auditor I** is responsible for evaluating the quality of...Included are processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Molina Healthcare (Rochester, NY)
- …updates/changes within claims processing system . + Experience using claims processing system (QNXT). ** PREFERRED EDUCATION:** Bachelor's Degree or ... equivalent combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working… more
- Albany Medical Center (Albany, NY)
- …Under the direction of the Director of Pharmacy the Pharmacy Revenue Integrity Auditor will serve as a pharmacy liaison and interface with finance, billing, revenue ... billing practices by reviewing patient records, medication orders, and insurance claims to identify and correct potential pharmaceutical billing errors. They are… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new clinical staff, as needed. + Mentors (to others… more
- University of Rochester (Rochester, NY)
- …OIC leadership to determine corrective action, such as formal self-disclosures or claim adjustments + Assists in responding to external audits and government ... integrated health system, an Academic Medical Center, or other comparable setting preferred . + **Certifications** + One of the following credentials is preferred… more
- Catholic Health (Buffalo, NY)
- …for the people, carrying out and documenting the appeals process for denied claims denied due to reasons including, but not limited to clinical documentation/support ... field + Registered Nurse with a four (4) year degree and Unrestricted NYS RN license, preferred + Holds, or will obtain within one year of hire, one of the following… more