- Air National Guard Units (Newburgh, NY)
- …must provide OFFICIAL transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof ... that you meet the Education requirements for this position. Additional Information If you are a male applicant who was born after 12/31/1959 and are required to register under the Military Selective Service Act, the Defense Authorization Act of 1986 requires… more
- Pfizer (New York, NY)
- …financial assistance brochures. + Reactively assisting HCP offices with coding and claims -related issues by contacting payers to understand policy or procedures and ... to provide information on payer requirements. + Compliantly use Pfizer's designated case notes system The Field Reimbursement Manager is to be the subject matter expert on reimbursement and coverage issues affecting Pfizer products in their assigned regions… more
- Molina Healthcare (Albany, NY)
- …credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. * ... Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. * Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have… more
- Healthfirst (NY)
- …in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and… more
- Arnot Health (Elmira, NY)
- …payer policies) + Assist in claim edit resolution to ensure compliant, clean claims are submitted + Maintain proficiency in CPT, HCPCS, ICD-10, OPPS, and related ... coding structures + Collaborate with Finance and IT to troubleshoot revenue-related system issues + Update internal procedural documentation based on regulation or policy changes + Develop and maintain tools for revenue tracking and compliance monitoring What… more
- Hartford Steam Boiler Inspection and Insurance Company (New York, NY)
- …enhancements and product strategies in collaboration with HSB's underwriting, claims and engineering units. Qualifications Education and Experience: + Bachelor's ... degree in Actuarial Science, Statistics, Economics, Finance, Mathematics, or related fields requiring modeling, programming, or quantitative analysis; alternatively, equivalent work experience. + Passed at least five (5) actuarial exams. + Four (4) or more… more
- Molina Healthcare (Rochester, NY)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts,… more
- CDPHP (Latham, NY)
- …information required. + Chronic Conditions knowledge preferred. + Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred. ... + Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required. + Experience with Clinical Documentation Improvement preferred. + Demonstrated knowledge of medical record review and diagnosis coding within the health insurance… more
- CVS Health (Albany, NY)
- …Summary** The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the ... negotiation role, and understanding (U&C) calculated rates and benchmarking of medical costs. The individual will be developing their role as a negotiator, working with training staff, and team members as more complex cases and strategies are developed.… more
- Hannaford (Clifton Park, NY)
- …claim forms. * Maintain organized filing system for invoices, manual insurance claims , daily reports, etc. in accordance with Standard Practice Manual and state ... law. * Help customers find over the counter items. * Maintain a broad understanding of HBC MPP scheduling system. * Assist in data entry of MPP information. * Maintain attendance and vacation log information. * Understand Pharmacy Standard Practice Manual. *… more