- Molina Healthcare (Buffalo, NY)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments...years operational managed care experience (call center, appeals or claims environment). + Health claims processing… more
- CDPHP (Albany, NY)
- …full responsibility for the completion of the necessary activities related to the processing of incoming mail for the entire organization, as well as the timely ... and accurate facilitation and handling of all incoming paper claim and correspondence documents. All tasks are performed on-site. This includes performing a detailed… more
- Baylor Scott & White Health (Albany, NY)
- …issues. + Knowledge and expertise of medical benefit policies and plan designs, claims hospital and medical processing , and adjudication with data skills. + ... needed + Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and… more
- Highmark Health (Albany, NY)
- …experience as demonstrated by proficiency in one or more of the following areas: claims processing , adjusting or membership is required. Two (2) years Customer ... fraud cases and forwards to Special Investigations Unit. E3. Adjusts claims : *Performs online transactions and/or adjustments. *Determines claim disposition… more
- City of New York (New York, NY)
- …VA Claims , Provide Veteran Benefits Counseling: Possess high-level knowledge of processing claims for Veteran benefits from the VA. Trainings and ... In addition, the Senior Executive Director will also be a subject matter expert in processing VA claims for Veteran benefits and supervising staff on how to… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- …affiliates + Builds and manages relationships with Payers to identify and resolve claim billing and processing issues + Works collaboratively within Revenue ... Functions 70% Auditing and Corrective Action + Evaluates charge capture, claims scrubbing and sliding fee discount practices to ensure efficiency, accuracy,… more
- Molina Healthcare (Buffalo, NY)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...SAI targets are met. + Leads efforts to improve claim payment accuracy and financial performance without needing extensive… more
- CVS Health (Albany, NY)
- …analytical, critical-thinking, and problem-solving skills. **Preferred Qualifications** + Claims processing experience. + Customer service experience. ... related to Network contracts and agreements. + Research identified issues; submit claim adjustment requests and determine the root cause of disputes. + Serve… more
- Callen-Lorde Community Health Center (New York, NY)
- …patient service charges in EPIC, preparing and submitting electronic and paper claims , processing payments from third-party payers and patients, and managing ... codes with proper sequencing and modifiers, reviewing and validating coding for denied claims , and serving as a coding resource for the billing department to ensure… more
- FLACRA (Newark, NY)
- …FLACRA's billing and payment collection processes. This position is responsible for processing claims , managing accounts receivable, and ensuring timely and ... up on outstanding balances. + Work with insurance companies to address disputed claims and resolve processing issues. + Maintain and update tracking spreadsheets… more