- Humana (Albany, NY)
- …community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to ... data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with… more
- Highmark Health (Albany, NY)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical documentation,… more
- Arc Allegany-Steuben (Hornell, NY)
- …requirements. Financial Management + Review, prepare, and submit Self Direction billing claims through eVero on a monthly basis. + Cross-check units utilized against ... confirm services do not exceed participant allocations. + Reconcile denied or rejected claims , correct errors, and resubmit promptly to ensure timely payment. + Run… more
- Ellis Medicine (Schenectady, NY)
- …EXPERIENCE REQUIREMENTS: + Education: High School Diploma or Equivalent required. Associate 's degree preferred. + Experience: 2 years of accounts receivable ... outstanding accounts receivable with insurance companies and patients. + Claims in dispute with payers are reviewed daily to...the provider and payers are in agreement for appropriate claims reimbursed. + Monthly meetings with all payers to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... in FWA investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies;… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …and external regulations. This position reports directly to the Associate Director, CNS Scientific Communications. **Job Description** **Key Responsibilities ... **Core Content Development** + Under the guidance of the Associate Director, Medical Communications, draft and maintain high-priority, foundational scientific… more
- City of New York (New York, NY)
- …enforcement tools to address allegations of discrimination. Reporting to the Associate Commissioner for Law Enforcement, the Supervising Attorney will help manage ... in conducting interviews with members of the public alleging claims of discrimination in employment under the NYCHRL and...and at bar associations. - Advising the Deputy & Associate Commissioner on proposed legislation and other policy matters.… more
- New York State Civil Service (Melville, NY)
- …only Case Manager in the NYS Segment.* Work-up and process Workers' Compensation claims .* Approve and deny medical bills.* Respond to claimant and provider inquiries ... via phone and email.* Routinely communicate with employers to obtain info about claims .* File forms and correspond with the Workers' Compensation Board.* Review … more
- Guidehouse (New York, NY)
- …this position include: + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity ... and associated coding modifiers. + Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system. +… more
- Humana (Albany, NY)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... operational knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). + Collaborate with each Insurance Operations… more