- Elevance Health (Latham, NY)
- **Nurse Case Manager II ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... 11:30 AM to 8:00 PM EST. The **Nurse Case Manager II ** is responsible for care management...as applicable. + Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II ** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible for care management...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to...assigned to non-care managers are monitored by the care manager + The care manager provides feedback… more
- WSP USA (New York, NY)
- This Opportunity WSP USA is initiating a search for a **Project Officer/Construction Manager ** in **New York City** (all 5 boroughs) supporting our client, School ... SCA's resources on such change orders + Review contractors claims or disputed work and advise senior management as...and project documentation necessary for adjudicating or denying such claims . + Visit various job sites as required in… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... claims , submitting appeals and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative II reports to Accounts… 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, ... and required. + Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) + Performs more complex investigations… more
- BronxCare Health System (Bronx, NY)
- …collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement ... (CQI) teams, consistent adherence to the specific rules and regulations of The Dr. Martin Luther King, Jr. Health Center (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Interacts with Operations, Enrollment and Billing, Customer Care, Claims , Advocacy, Clinical Operations, Medical Affairs and Finance/Underwriting Departments ... ownership and accountability for issue identification and resolution. Level II (in addition to Level I Accountabilities) * Assists...issues. * Acts as a back up to Account Manager when individual is out of the office. Minimum… more
- Ellis Medicine (Schenectady, NY)
- This position can be local or remote!! The Medical Coder II is responsible for the revenue cycle activities of specific physician practices of Ellis Medical Group ... and related work lists to ensure complete, timely and accurate submission of claims , (3) facilitating the accuracy and completeness of the practice's codes and… more
- Elevance Health (Latham, NY)
- **Utilization Management Representative II ** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law._ The **Utilization Management Representative II ** is responsible for managing incoming calls, including triage, opening of… more