- 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, ... **Responsibilities** 1. Analyzes data requests using information technology, enrollment, claims , pharmacy, clinical, contract, medical management, financial, administrative and… more
- Molina Healthcare (Albany, NY)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Truecare Homecare Agency (Brooklyn, NY)
- …all documentation to centralized location + Participate in data retrieval for claims appeals and requests for payment + Liaison between the insurance companies ... phone/fax management skills, computer documentation of codes and information for claims Required Qualifications: + High School Graduate/ GED equivalent +… more
- Compass Group, North America (Brooklyn, NY)
- …Office Risk Management team in responding to or managing any safety and claims issues* Working with operations and culinary teams to ensure the timely completion ... and settling of team members, foodborne illness, liquor liability and guest claims * Work with local OSHA, sanitation or Everclean inspectors to support inspections… more
- Walgreens (Delhi, NY)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …work streams, including: Client Implementation, Enrollment & Eligibility, Claims processing & Reimbursements, Member/Provider self-service, Customer Service, Legal ... resource planning. + Manage various file integrations including eligibility, accumulators, claims , etc. + Create an efficient process to manage client… more
- CVS Health (Amherst, NY)
- …setup essential for online viewing and processing related to Customer Service, Claims , Enrollment, Billing and Reporting in support of internal and external ... experience with benefits interpretation **Preferred Qualifications** + Customer Service, Claims , and or Plan Build preferred + Salesforce experience preferred… more
- Humana (Albany, NY)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- MetLife (Oriskany, NY)
- …Disability (STD), State Plans, PFML, and concurrent Absence Management Solutions (AMS) claims to ensure we meet or exceed customer expectations. Will engage business ... related field or equivalent experience * 7-8 years of related disability claims administration experience Preferred: * Prior training or management experience *… more
- New York eHealth Collaborative (New York, NY)
- …large and complex datasets (eg, master patient indexes, SPARCS, healthcare claims ). + Design, implement, maintain, and enhance data workflows, ETL/ELT pipelines, ... audiences. + Familiarity with Clinical Quality reporting, Medicare and Medicaid claims data, ICD coding, CDA standards, web scraping, EHR/EMR systems, and… more