- 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
- Centene Corporation (Latham, NY)
- …management experience (medical management, provider relations, contracting, compliance, claims or member/provider services) preferred. Knowledge of NCQA and ... HEDIS technical specifications. Master's degree preferred. **License/Certificates:** Current state's RN license preferred. Certified Professional in Health Care Quality preferred.Pay Range: $145,100.00 - $268,800.00 per year Centene offers a comprehensive… more
- AECOM (New York, NY)
- …Work with management and staff to resolve pre-litigation disputes and potential claims + Supervise and manage litigation, including professional liability, breach of ... contract, and personal injury/wrongful death matters, utilizing outside counsel retained by the company to maximize quality and cost-effectiveness + Manage external counsel and litigation budgets + Handle subpoenas, document requests, and other litigation… more