• Director, Grievance and Appeals

    Humana (Albany, NY)
    …degree + Strong knowledge of CMS Grievance regulations **Additional Information** Work at Home /Remote Requirements **Work- At - Home Requirements** + ... efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify...Home /Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and… more
    Humana (05/30/25)
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  • Medical Records Coder III

    University of Rochester (Rochester, NY)
    …review codes created by electronic charge capture and/or assigns codes through medical record documentation as per designated workflow. + Completes system edit ... make corrections before transmittal. + Troubleshoots problems that prevent claims from being released. + Identifies cause of edit...+ High School diploma or equivalent and 1 year Medical Coder experience required + Associate's degree preferred +… more
    University of Rochester (06/04/25)
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  • Administrative Assistant III

    University of Rochester (Brighton, NY)
    …Prepares, processes, and reviews forms for compliance, accuracy, and completion including medical documentation. Determination of how to classify claims (WC- ... medical only or loss time or if multiple claims how to address concurrent DBL and WC ...western New York, Rochester is our namesake and our home . One of the world's leading research universities, Rochester… more
    University of Rochester (03/17/25)
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  • Senior Encounter Data Management Professional

    Humana (Albany, NY)
    …skills to make an impact** **Required Qualifications** **5 years of medical claims processing/auditing or encounter data management experience** **Demonstrated ... team leadership experience** **Demonstrated experience in managing projects effectively** ** Medical claims experience** **Additional Information** **_This position… more
    Humana (05/31/25)
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  • Billing Coordinator II

    Modivcare (NY)
    …are. We serve the most underserved by facilitating non-emergency medical transportation (https://www.modivcare.com/offerings/nemt) and personal and home care ... submissions, resubmissions or back billing, resolve denied or rejected claims , including researching accounts, analyzing EOBs, and interacting with insurance… more
    Modivcare (06/06/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Albany, NY)
    **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee **Relocation assistance:** is not available for this ... opportunity. **Requisition #:** 74371 **The Role at a Glance** We are excited to bring on...position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In… more
    Lincoln Financial (06/10/25)
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  • Healthcare Payment & Financing Innovation Senior…

    City of New York (New York, NY)
    …health outcomes for all New Yorkers. CHECW sits under the Agency's Chief Medical Officer. The Bureau of Equitable Health Systems (BEHS) is the healthcare systems ... practical expertise to improve equity in health care delivery at the individual, organizational, and systems levels. We do...all New Yorkers. CHECW sits under the Agency's Chief Medical Officer. The Bureau of Equitable Health Systems (BEHS)… more
    City of New York (05/25/25)
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  • Utilization Management Services Rep I/II/III…

    Excellus BlueCross BlueShield (Rochester, NY)
    …fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I + Facilitates inbound and outbound ... training to UM Services Reps. + Collaborates with other key departments ( Claims , Customer Service, related care management units) to ensure end-to-end process for… more
    Excellus BlueCross BlueShield (05/29/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Albany, NY)
    …Review & Pharmacy. This is a fully remote position, offering the flexibility of a home -based office. As the AVP of Utilization Review & Pharmacy, you will lead and ... the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds'...for business results and works with Managed Care and Claims leadership to create and align utilization and pharmacy… more
    Zurich NA (05/22/25)
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  • Manager, Trade Compliance (Duty Optimization)

    Corning Incorporated (Corning, NY)
    …You can help connect the unconnected, drive the future of automobiles, transform at - home entertainment, and ensure the delivery of lifesaving medicines. And so ... help move our company, and the world, forward. ​ ​ At Corning, there are endless possibilities for making an...to prepare duty drawback, Post Submission Corrections, or Protests claims accurately and in compliance with customs regulations. +… more
    Corning Incorporated (05/24/25)
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