- Molina Healthcare (Rochester, NY)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS… more
- City of New York (New York, NY)
- …recruiting for one (1) PAA III position to function as the Human Services Payment Analyst in the DHS Human Services Unit who will: - Perform quality assurance review ... and CARES within the prescribed period. - Reconcile monthly claims and maintain a claim-control register to ensure the...Office of Budget Administration and the NYC Office of Management and Budget. - Monitor the invoices against the… more
- Amazon (New York, NY)
- Description Amazon One Medical is hiring a Actuarial Manager Analyst . Actuarial rigor is one of the keys to our success. This candidate will responsible primarily ... -Medical economics reporting and ad-hoc analysis relating to cost of care management -Medicare Risk score projections and premium estimation -Design and implement an… more
- Cardinal Health (Albany, NY)
- …Improvement is responsible within the sales organization for program/project management relative to the development of sales tools for productivity ... data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that… more
- University of Rochester (Rochester, NY)
- …timely, accurate reporting related to insurance laws and regulatory requirements, management of FASB standards, as well as university policies and procedures. ... and datasets related to, but not limited to, enrollment, premiums, claims , payments, prescription rebates, and stop-loss insurance to ensure proper booking… more
- Highmark Health (Albany, NY)
- …Utilize robust, data-driven insights from complex healthcare datasets (eg, claims , clinical, utilization, pharmaceutical) to inform policy development, identify ... 7 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 5 years of project leadership… more
- Intermountain Health (Albany, NY)
- …documentation requirements, and reimbursement policies, as well as ensures claims meet medical necessity for procedures performed. **Essential Functions** + ... providers for clarification or additional information when needed. + Submits coded claims to billing department or third-party payers in a timely manner. +… more
- BronxCare Health System (Bronx, NY)
- …participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in ... Bronx-Lebanon Hospital Center (a) Safety and Security Policies, (b) Risk Management : Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures… more
- Molina Healthcare (Syracuse, NY)
- …opportunities for cost savings. + Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key ... care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of… more
- World Insurance Associates, LLC. (Syosset, NY)
- …and bonding, employee benefits, financial and retirement services, and human capital management solutions. Our rapid growth and market leading presence has created ... cases + Create monthly financial reporting packages including detailed premium, claims , membership, commission, and cash reconciliation information + Create weekly,… more