- Centene Corporation (New York, NY)
- …DRG, HCPC reimbursement methodologies. + Documents rate negotiation accurately for proper claims adjudication . + Acts as liaison between the TRICARE beneficiary ... and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. + Identifies and refers potential cases to Disease Management, Case Management, Demand Management and… more
- MetLife (New York, NY)
- …Key Responsibilities * Date science in Dental: Contributions to underwriting models, claims auto- adjudication logic and models, fraud waste and abuse analyses ... and models (mostly provider-related), dental network analyses, consumer analytics, network expansion analytics and much more. * Leads and contributes to data analysis and modeling projects from project/sample design, business review meetings with internal and… more
- Sanofi Group (Albany, NY)
- …medical payer policy requirements, buy & bill processes, billing and coding education, claims and adjudication by site of care, financial assistance offerings ... from patient support program, and billing of Sanofi T1D products by health care providers and/or healthcare facilities. + Act as the main point of contact for the Patient Support Services Hub, and communicate and collaborate cross-functionally to lead Pull… more
- MVP Health Care (Rochester, NY)
- …interaction **Your key responsibilities:** + Responsible for overseeing the end-to-end adjudication and processing of claims across Medicaid, Medicare, ... thinking and continuous improvement. To achieve this, we're looking for a Leader, Claims Operations, to join #TeamMVP. If you have a passion for leadership, team… more
- New York State Civil Service (Oxford, NY)
- … claims ; determine final resolution. Contact payers on incorrectly paid claims completing resolution and adjudication . Adjusts accounts or processes insurance ... NY Zip Code 13830 Duties Description Will perform medical billing and claims processing, including payment, coordination or subrogation of benefits. Review claims… more
- University of Rochester (Rochester, NY)
- … claims ; determines final resolution. + Contacts payers on incorrectly paid claims completing resolution and adjudication . + Adjusts accounts or processes ... open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Researches, corrects, resubmits … more
- University of Rochester (Albany, NY)
- … claims ; determines final resolution. Contacts payers on incorrectly paid claims completing resolution and adjudication . Adjusts accounts or processes ... open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Researches, corrects, resubmits … more
- CVS Health (Albany, NY)
- …and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- Molina Healthcare (Yonkers, NY)
- …Partners to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- University of Rochester (Rochester, NY)
- …payment methodology, including add-ons + Follow up with payers on incorrectly paid claims through final resolution and adjudication , including refund of credits ... independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues that affect… more