- Molina Healthcare (Rochester, NY)
- …execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as ... Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate payment levels, optimize resource utilization,… more
- Molina Healthcare (Albany, NY)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis… more
- University of Rochester (Rochester, NY)
- …to insurance companies to determine reason for claim denial or reason for unpaid claim . Address unpaid claims , and solicit a payment date from the payer. - - ... - Research and calculate underpaid or overpaid claims ; determine final resolution.- - - Re-calculate ...of credits - - Review and advise supervisor or manager on trends of incorrectly paid claims … more
- University of Rochester (Rochester, NY)
- …received. + Documents all actions thoroughly in visit notes. 30% Corrects claim errors returned post-submission. + Reviews claims requiring non-routine ... of the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claim Resolution Rep II is responsible for the accurate and timely… more
- University of Rochester (Rochester, NY)
- …conforms to federal and state regulations bringing concerns to the attention of billing Manager and Supervisor. The Claim Resolution Rep III will represent the ... not been collected through routine billing and collection activities. Claim Resolution Rep III will make independent decisions as...insurance refund credits. + Review and advise supervisor or manager of trends on incorrectly paid claims … 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 ... the ENERGY TRANSITION. Our TEAM is ready. The Contract Manager will lead Contract Management support in the execution...commercial expert in preventing and mitigating high dollar value claims and risks. In this role, you will: +… more
- Tutor Perini (White Plains, NY)
- …future Frontier-Kemper, a Tutor Perini Company, is seeking a **Change Control Manager ** to join our Kensico-Eastview Connection Tunnel Project in White Plains, New ... **_Extraordinary Projects need Exceptional Talent_** **DESCRIPTION:** As a **Change Control Manager ** at Frontier-Kemper, reporting to the **Project Manager ,**… more
- GE Vernova (Schenectady, NY)
- **Job Description Summary** Job Description Summary The Contract Manager supports the project team on all contractual issues (ranging from equipment (EO/EEP) and ... project execution and ensures that commercial risks and opportunities (notably claims , change orders, vendor and insurance recoveries) are identified early, tracked,… more
- Molina Healthcare (Albany, NY)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more
- University of Rochester (Rochester, NY)
- …to insurance companies to determine reason for claim denial or reason for unpaid claim . Address unpaid claims , and solicit a payment date from the payer. + ... Research and calculate underpaid or overpaid claims ; determine final resolution.- - - Re-calculate ...refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims … more