- 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
- Cardinal Health (Albany, NY)
- …patient medical records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise EMRs, the registration process ... and charge entry. + Supports the overall workplan of the Compliance Department. + Other duties as assigned. **_Qualifications_** + 8-12 years of experience, preferred + Bachelor's degree in related field, or equivalent work experience, preferred* Bachelor's… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: Candidate will be responsible for following up on medical claims including but not limited to follow up on claim submissions, investigating patient ... accounts, resolving denials, and fielding all incoming correspondence. Candidate will answer incoming phone calls from patients pertaining to billing, insurance, and payments. Minimum Qualifications: 2-3 years Medical Billing Experience- Radiology preferred… more
- CVS Health (Albany, NY)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality. Additional responsibilities to include but not limited to the following: - Responsible… more
- The Walt Disney Company (New York, NY)
- …and/or witness testimony. + Researching and resolving copyright and other claims and/or other inquiries regarding news materials, as necessary. + Providing ... vacation coverage for other lawyers in the group, which may involve working on nights or weekends. + Interpreting existing group and ABC News policies and supporting the objectives articulated by higher level lawyers in the group and the Disney Legal… more
- Humana (Albany, NY)
- …on beneficiary needs; assists with beneficiary related issues which may include claims inquiries, enrollment issues, travel attestations, access to care, wait lists, ... coordination of services and other non-clinical beneficiary concerns. + Assist in researching and providing community resources when appropriate. Interface with providers as necessary and appropriate for issue follow-up and resolution. Discuss identified… more