- 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, ... All Levels + Must meet the NYS DFS's and the NYS OMIG's minimum investigator requirements as follows: Persons employed by the SIU as investigators shall be qualified… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator ** to join #TeamMVP. This is the opportunity for you if you have ... justice or a related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation experience with law… more
- TEKsystems (Queens, NY)
- …of fraud. + Independently review, examine, and decision fraud and merchant dispute claims submitted by members to minimize the credit union's loss exposure, increase ... agreed risk levels and positive member experience are maintained. + Provide primary support and services to the branches and Contact Center representatives via email… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Insurance Fund, State Title Claims Services Representative 1/Trainee 1/2 - NYHELPS Occupational Category Other Professional Careers Salary Grade ... 12206 Duties Description Under the general supervision of a Claims Services Representative 2 responsibilities include, but are not...with case analysis over the anticipated life of the claim * Recommend cases for appeal to WCB* Negotiate… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE ASSOCIATE FRAUD INVESTIGATOR CIVIL SERVICE TITLE. The DSS Accountability Office (DSS-AO) is responsible for ... DSS complies with all statutory, regulatory, and contractual standards. The Division of Claims and Collections Division (C&C) is housed within the office of Revenue.… more
- Mount Sinai Health System (New York, NY)
- …to ensure vendor-delivered services meet or exceed contractual obligations and support enterprise revenue cycle transformation initiatives. The Director will report ... in relevant RCM modules (eg, Resolute Professional Billing, Hospital Billing, Claims , Contract Management) strongly preferred. + Minimum 7-10 years of progressive… more
- Mount Sinai Health System (New York, NY)
- …. Ensure authorization workflows align with revenue cycle best practices to reduce claim denials, improve cash collections, and enhance clean claim rates. . ... controls and audit readiness for all authorization-related processes. . Support organizational goals related to patient satisfaction, clinical efficiency, and… more
- Mount Sinai Health System (New York, NY)
- …process issues. + Ensures workflows align with revenue cycle best practices to reduce claim denials, improve cash collections and enhance clean claim rates. + ... payer mix and leads team in building plans to support operational departments to achieve best practice performance through...and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges.… more
- Regeneron Pharmaceuticals (Sleepy Hollow, NY)
- …Manager, a typical day may include:** + Act as the lead investigator on employee concerns including devising investigation strategies, reviewing data and documents, ... legal teams and HR leadership to address Ethics Points claims + Appropriately document, maintain, and handle sensitive and...including at least 4 years direct expereince as an investigator for Employee Relation matters** Does this sound like… more
- Mount Sinai Health System (New York, NY)
- …* Structure and perform analyses to measure outcomes, communicate impact, and support strategic decision-making (ie, financial, clinical, and claims analyses) * ... roles ? Advanced analytical capabilities required, experience with healthcare claims analysis and clinical quality measures highly preferred ? Experience… more