- Molina Healthcare (Buffalo, NY)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
- Molina Healthcare (Albany, NY)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
- Molina Healthcare (NY)
- …statuses and risks, and facilitating calls with cross-functional teams + Claims processing , provider contacting, health data analysis and reporting, ... rejection inventory, and works with other areas including IT, health plan, claims , provider, enrollment, regulators, and external vendors, as needed, to remediate… more
- Rochester Regional Health (Rochester, NY)
- …actions. RESPONSIBILITIES: + Medical Billing Expertise: Proficient in billing, claims processing (Inpatient, Outpatient, Critical Access, Rural Health), ... terminology, physician fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing : Submits and follows up on insurance claims ;… more
- Independent Health (Buffalo, NY)
- …Reliance Rx Operations & Compliance department. + Experience working with online claims processing system preferred. + Effective oral and written communication ... primarily responsible for completing the billing of both pharmacy and medical claims and adjudicating rejections. **Qualifications** + High school diploma or GED… more
- Molina Healthcare (Syracuse, NY)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- Molina Healthcare (Rochester, NY)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- Mount Sinai Health System (New York, NY)
- …Accounts Receivable, Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and ... problem resolution to ensure accurate and timely payment of claims and collection. The Specialist works directly with the...+ 5 years experience in medical billing or health claims , with experience in IDX billing systems in a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Medicaid, CPT, HCPCS, ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems, claims flow, adjudication process, system edits ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- BGB Group (New York, NY)
- …data integration + Experience with Google BigQuery, Cube.dev, and GCP products for claims data processing + Proficient in Python for analytics and visualization ... + Experience with Google BigQuery, Cube.dev, and GCP products for claims data processing + Proficient in Python for analytics and visualization + Strong… more
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