- Centene Corporation (New York, NY)
- …to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, or unusual or new services in order to ... determine medical necessity and appropriate payment. + May develop alliances with the provider community through the development and implementation of the medical management programs. + As needed, may represent the business unit before various publics both… more
- Publicis Groupe (New York, NY)
- …* Drive integration of data partners (eg, identity graphs, retail media networks, claims data) into targeting strategies. * Stay ahead of data privacy regulations ... and platform policy changes to inform compliant audience practices. **Qualifications** * 10+ years of experience in media strategy, digital marketing, or data-driven performance roles. * Proven track record of building and optimizing audience-based media… more
- Kyndryl (Albany, NY)
- …Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the US is ... $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be… more
- City of New York (New York, NY)
- …laws in the nation. Through its Law Enforcement Bureau (LEB), the Commission accepts claims filed by the public, and has the power to initiate its own investigations ... to affirmatively root out discrimination, harassment, retaliation and other violations of the NYCHRL. The Commission's Community Relations Bureau (CRB) is empowered to take action against prejudice, intolerance, bigotry, discrimination and bias-related… more
- Molina Healthcare (Syracuse, NY)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- NBC Universal (New York, NY)
- …make sure insurance requirements are fair and achievable. + Handle insurance claims from start to finish-analyzing coverage, investigating issues, and pushing for ... timely, favorable outcomes. + Create and maintain clear, consistent risk management processes and documentation. + Oversee the department's budget, including premiums and operational costs. + Develop and lead junior team members as needed. What You Bring: +… more
- The Institute for Family Health (New Paltz, NY)
- …and facilitates resolution. + May be responsible for Claim Printing/Reviewing of printed claim forms for accuracy to ensure claims are paid timely. + May be ... denials are at optimal levels + Ensure daily/weekly/monthly medical claim submission. Resolve claim and remittance file...reports data on shared drive spreadsheets + Communicate to Director of Revenue Cycle and IT department changes required… more
- City of New York (New York, NY)
- …Bureau of Law and Adjustment (BLA), negotiates and approves all monetary settlement of claims and lawsuits involving the City of New York. BLA investigates and, when ... in the best interest of the city, settles pre-litigation claims for and against the City of New York....Based on the BLA's review and investigation of any claim , the City of New York may extend an… 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 ... services for NYC uninsured and under insured residents. Reporting to the Assistant Director of Patient Billing by working alongside a team of talented health… more
- New York State Civil Service (Albany, NY)
- …Duties Description The Pre-investigation Unit (PIU) has the responsibility of reviewing every claim of labor law violation, submitted to and under the purview of the ... have worked in NYS. The PIU staff review incoming claims and accept, reject, or recommend that claims...redress. If accepted by NYSDOL, PIU recommends where the claim should be routed for investigation. This pre-investigative work… more