- Molina Healthcare (Yonkers, NY)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
- Sedgwick (Albany, NY)
- …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- CDPHP (Albany, NY)
- …+ Demonstrated ability to determine, analyze and solve problems related to benefits, claims processing , claims and benefit appeals/complaints, enrollment and ... volume call center preferred. + A background in health insurance claims and appeals processing is preferred. + Experience with a documentation system to track… more
- Molina Healthcare (Yonkers, NY)
- …+ Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including ... and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing , and knowledge...Medicaid and Medicare claims denials and appeals processing , and knowledge of regulatory guidelines for Provider No… more
- Healthfirst (NY)
- …+ Experience in Healthcare/Health Plan customer service, operations, vendor management, or claims processing . + Previous work experience in an auditing function ... understanding of healthcare Operations processes and supporting systems such as Claims Processing , Enrollment & Billing, and Member Services. + Knowledge of at… more
- Molina Healthcare (Syracuse, NY)
- …Ensure that provider information is loaded accurately to allow for proper claims processing , outbound reporting and directory processes. **JOB QUALIFICATIONS** ... for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims… more
- MTA (Brooklyn, NY)
- …Operating Authority, which includes the New York State Department of Labor claims processing , hearings, appeals, adjournments, remands and quarterly audits. ... and efficiently in compliance with mandated deadlines. Review UI claims before submission to the DOL and also review...before submission to the DOL and also review NF claims before submission to various insurance companies. Serves as… more
- OLV Human Services (Lackawanna, NY)
- …operations. A critical part of the role involves evaluating insurance coverage, managing claims processing , and ensuring all aspects of patient care are ... with Finance to ensure patient charts are updated appropriately, if claims are denied/rejected. + Implement and maintain systems for insurance verification,… more
- DePaul (Rochester, NY)
- …and Claims Manager to manage the organization's insurance procurement and claims program. This includes managing the reporting, processing , and adjustment of ... allocation of premiums by location etc. + Manage the reporting, processing , and adjustment of claims , including preparation and submission of notice of claims… more
- Healthfirst (NY)
- …Finance, or Business Administration from an accredited institution preferred. + Certification in claims processing or related area (eg, CPC, AIC) WE ARE AN ... Responsibilities:** + Oversee the enrollment process, ensuring timely and accurate processing of new and modified enrollments, renewals, and terminations. +… more