- Cognizant (Albany, NY)
- …to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued ... accounts. . Maintain working knowledge of applicable health insurers' internal claims , appeals, and retro-authorization as well as timely filing deadlines and… more
- Catholic Health Services (Melville, NY)
- …for accurate and timely hospital billing, follow up, collections, cash processing and customer service related activities. Responsibilities: + Reviews, corrects and ... approves all primary and secondary billing, submits hard copy or electronic claims to appropriate payors. + Reviews and edits any rejections stemming from electronic… more
- Molina Healthcare (Yonkers, NY)
- …as the Provider Online Directory, Utilization Management, Customer Experience, Enrollment, and Claims Payment and Processing . + Develop and enforce operating ... and business leaders to enable enterprise wide capabilities. Synchronizes data among multiple claims systems and application of business rules as they apply to each… more
- CVS Health (Albany, NY)
- …Quality, CPHQ preferred. + Background in Managed Care. + Familiarity with claims processing workflows. + Experience with quality improvement, PIPs, ANE ... requirements. + Apply clinical criteria and policies to member/provider claims and coordinate clinical resolutions with MD support. **Performance Improvement… more
- CVS Health (Albany, NY)
- …levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing , Provider Appeals & Disputes and Network Performance ... well as for internal staff and aligns Network functions with Operations and Claims as needed. + Collaborates with internal partners to assess effectiveness of… more
- Mount Sinai Health System (New York, NY)
- …knowledge of a health care EMR such as Epic/Clarity, eCW, etc.; a payor claims system such as Facets, Amisys, etc.; or a hospital/provider system such as IDX, ... and property. Identifies contingency plans for potential risks. + Strong data processing / transformation skills using tools like SQL, R, Python, PySpark, etc.… more
- New York State Civil Service (Endicott, NY)
- …responsible for the following;. Accept and process both original and continued claims for Unemployment Insurance. . Conduct telephone interviews with claimants in ... benefits.. Determine the need for further fact-finding and place claims on hold pending further investigation. Work a variety...to do so may result in a delay of processing your application.Candidates from diverse backgrounds are encouraged to… more
- WMCHealth (Poughkeepsie, NY)
- …lawsuit, etc.) and alerts the department director, medical staff leadership, and claims manager. + Conducts special studies in collaboration with medical staff on ... potential lawsuit, etc.) and alerts the department director, administration, and the claims manager. Initiates a more thorough review to clarify the circumstances. +… more
- MTA (New York, NY)
- …and support of the MTA benefits department, which includes the Benefits Processing , Customer Resolution & Support, Death Claims /COBRA/ & Leave Management, ... and Billing/ Claims units. The position will be tasked with independently working with internal clients, functional departmental partners, and external stakeholders such as benefit vendors to ensure effective service delivery and that key performance… more
- Norstella (Albany, NY)
- …to extract meaningful insights from **real-world data (RWD)** sources, including ** claims , laboratory results, billing codes, and electronic health records (EHRs)** ... teams to develop and refine database queries, data pipelines, and processing workflows, incorporating AI/ML methodologies for advanced analytics. + Partner with… more