- Humana (Albany, NY)
- …network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating ... committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives. **Use your skills to make an impact** **Required Qualifications** + 2 or more years of experience in negotiating managed care… more
- University of Rochester (Rochester, NY)
- …requests, necessary and appropriate medical terminology to use in order for claim to be approved, previous treatments that are necessary to report, appropriate ... verbiage for treatments that have been tried and not successful. Applies knowledge and protocols to varying degrees based on how complexities of the situation deviate from the norm. Resolves obstacles presented by the insurance company by applying knowledge… more
- University of Rochester (Rochester, NY)
- …requests, necessary and appropriate medical terminology to use in order for claim to be approved, previous treatments that are necessary to report, appropriate ... verbiage for treatments that have been tried and not successful (ie, medication could not be utilized due to heart condition). Applies knowledge and protocols to varying degrees based on how complexities of the situation deviate from the norm. Resolves… more
- University of Rochester (Rochester, NY)
- …for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and drafts for provider signature. ... Manages provider(s) documentation and information. Composes and types non-routine correspondence providing factual information. Arranges travel, conference registration, and hotel accommodations. Interfaces with organizations, hospitals, and others to… more
- Northwell Health (Plainview, NY)
- …identifying patients unable to afford medication; Identifying rejected pharmacy claims at patients' preferred pharmacy; and Initiating prior authorization process ... Participates in implementing and evaluating related Quality Assurance, Performance Improvement and Compliance programs. Assists Registered Pharmacist in the non-professional (non-judgmental) aspects preparing and dispensing medication: Fills, packages, labels… more
- University of Rochester (Dansville, NY)
- …signatures for non-routine letters of correspondence related to appeals on denied claims . This includes compiling all necessary information and drafts for provider ... signature. - Manages provider(s) documentation and information. Composes and types non routine correspondence providing factual information. - Arranges travel, conference registration and hotel accommodations. Interfaces with organizations, hospitals and… more
- University of Rochester (Rochester, NY)
- …for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and drafts for provider signature. ... + Manages provider(s) documentation and information. + Composes and types of non-routine correspondence providing factual information. + Arranges travel, conference registration and hotel accommodations. + Interfaces with organizations, hospitals and others to… more
- Ryder System (Albany, NY)
- …**Job Description** : **SUMMARY** This position handles worker's compensation claims under Ryder's self-insured, self administered worker's comp program. **ESSENTIAL ... FUNCTIONS** Investigates and resolves low to high exposure worker's compensation claims pursued against Ryder and our insured customers Ensures the most appropriate… more
- Travelers Insurance Company (Melville, NY)
- …**What Will You Do?** + CUSTOMER ENGAGEMENT: Serves as a customer service representative for the claim department by promptly and professionally addressing ... multiple departments to assist with the timely resolution of claims , which may include: Properly documents claim ...of claims , which may include: Properly documents claim files, including notes and diaries, Requests reports and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments across all Centers Plan for Healthy Living (CPHL) ... product offerings. + Thoroughly and efficiently gather claim information, assess and fulfill the caller's needs and...caller's needs and educate the caller where applicable regarding claim submission procedures. + Focus on resolving issues on… more