- Molina Healthcare (Albany, NY)
- …software and medical record vendors, and other Molina departments, such as Claims , Enrollment, IT etc,. to get appropriate responses and manage contracts and ... + Maximizes use of information from multiple sources, including claims /encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or… more
- Molina Healthcare (Syracuse, NY)
- …+ Responsible for encounters accuracy & completeness (ie, Encounter Production, Audit , Production Vendor Oversight) for assigned lines of business. Responsible for ... Ability to influence across multiple organizational functions - Payment Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in managing complex… more
- Molina Healthcare (Albany, NY)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Truecare Homecare Agency (Brooklyn, NY)
- …patient authorizations, informing supervisor of any expired dates + Review and audit all authorizations for appropriate codes and units before entering into system ... all documentation to centralized location + Participate in data retrieval for claims appeals and requests for payment + Liaison between the insurance companies… more
- City of New York (New York, NY)
- …of Homeless Services (DHS). DSS-AO maintains the operation of the Office of Audit Services (OAS) and Office of Quality Assurance (OQA), Office of Accountability ... and/or systems. - Design, test, and implement the process to evaluate claims for skimming reimbursement in a batch, data-driven manner, with 100% accuracy… more
- Nestle (New York, NY)
- …necessary related to the Safety Management program. + Ensure sites maintain continuous " audit ready" state of compliance with company SH&E policies and procedures as ... as all applicable external regulatory requirements. + Initiates WC Claims to insurance provider. + Ensure all locations have...locations have preferred HCP locations. + Follow up on Claims as required. + Partners with Human Resources and… more
- Ankura (Lexington, NY)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... team of industry experts with backgrounds in compliance, regulatory, legal, audit , operations, nursing, pharmacy, medical science, economics, accounting, and data… more
- Tompkins Community Bank (Batavia, NY)
- …(CL) Department in the handling and processing of new and renewal business, claims and special projects. It will provide in-house customer service to clients, as ... and billing of audits, notifying account team if the audit resulted in 25% or $2,000 (whichever is greater)...+ Assist with First Notice of Loss and Reporting Claims to carriers, setting up ImageRight for the Claim.… more
- Broadridge Financial Solutions (Edgewood, NY)
- …requests are precise, simplified and value add (eg, serve as a liaison between claims admin request and clients to ensure that communications are clear, concise, and ... upon schedule + Track all filing deadlines and ensure claims have been filed timely + Ensure all deficiency...have been filed timely + Ensure all deficiency and audit deadlines are tracked and responded to timely +… more
- CUNY (Queens, NY)
- …accounts and in performing reconciliations. - As instructed, examines invoices, claims , vouchers, etc.; verifies documents for accuracy by reviewing supporting data ... and records and assists in audit functions. - As authorized, receives remittances and payments;...issues pertinent receipts. - Assists in processing invoices, vouchers, claims , statements, bills, etc. - Perform various calculations and… more