- J&J Family of Companies (Smithtown, NY)
- …on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local ... payers, government payers, etc.) for core and launch products. . Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team. . Act with a sense of urgency to address… more
- J&J Family of Companies (New York, NY)
- …on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local ... payers, government payers, etc.) for core and launch products. + Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team. + Act with a sense of urgency to address… more
- J&J Family of Companies (Newburgh, NY)
- …on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local ... payers, government payers, etc.) for core and launch products. + Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team. + Act with a sense of urgency to address… more
- Molina Healthcare (Buffalo, NY)
- …+ SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting ... and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made… more
- CVS Health (Albany, NY)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... prepares cases for clinical and legal review. + Documents all appropriate case activity in case tracking system. + Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law. + Facilitates the recovery… more
- Walmart (Watertown, NY)
- …in accordance with company policies and procedures by properly handling claims and returns; zoning the area; stocking, arranging and organizing merchandise; ... setting up, cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise according to company policies and procedures; identifying shrink and damages; and securing fragile and high-shrink merchandise. Monitors food and… more
- City of New York (New York, NY)
- …The work of DFS includes managing the ACS budget; submission of monthly claims for revenue; processing of payments to provider agencies and vendors; monitoring the ... financial health of provider agencies through financial review and audits; maintenance of the ACS bank accounts; centralized oversight of ACS Child Welfare financial eligibility; and data maintenance for financial systems of record. The Child Welfare Payments… more
- Molina Healthcare (New York, NY)
- …SKILLS & ABILITIES** : * 3 - 5 years customer service, provider service, or claims experience in a managed care setting. * 3+ years experience in managed healthcare ... administration and/or Provider Services. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation and various… more
- BronxCare Health System (Bronx, NY)
- …collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement ... (CQI) teams, consistent adherence to the specific rules and regulations of the BronxCare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and… more
- ASM Global (Buffalo, NY)
- …process as requested. + Partnership in the processing of worker's compensation claims , leaves of absences, benefits administration. + Develops and facilitates talent ... development, including materials and initiatives. + Must exhibit an active interest in company and venue specific operational knowledge as it relates to providing value added HR business partnership. + Demonstrate thought leadership and suitable judgment in… more