- Humana (Albany, NY)
- …Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience ... it takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, and… more
- Highmark Health (Albany, NY)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- Molina Healthcare (NY)
- …encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** ... Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education**… more
- Cognizant (Albany, NY)
- …will make an impact by configuring and maintaining QNXT systems to ensure accurate claims processing and compliance with client requirements. You will be a ... **back-end queries** and validate configuration setups to ensure accurate claim processing . + Advise clients on **configuration decisions** in collaboration with… more
- Mount Sinai Health System (New York, NY)
- …This role ensures that all team members involved in patient registration, billing, claims processing , denial management, and collections are equipped with the ... and reports. + Strong experience with vendor contract management and invoice processing . **Knowledge, Skills, and Abilities** 1. Demonstrated success in a large… more
- Bowery Residents Committee (Manhattan, NY)
- …+ Highly proficient with Microsoft Office tools. + Prior knowledge of electronic claims processing would be preferred. *Vaccination preferred but not required. ... for accounts receivable processes and daily cash receipts. Accurate and timely processing of billings, receipts, and related payments. Perform analysis of assigned… more
- Molina Healthcare (Syracuse, NY)
- …managed care or payer environment. + In-depth knowledge of medical and hospital claims processing , including CPT/HCPCS, ICD, and modifier usage. + Strong ... requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role… more
- FLACRA (Newark, NY)
- …FLACRA's billing and payment collection processes. This position is responsible for processing claims , managing accounts receivable, and ensuring timely and ... outstanding balances. + Work with insurance companies to address disputed claims and resolve processing issues. + Maintain and update tracking spreadsheets for … more
- University of Rochester (Rochester, NY)
- …through telephone calls, payer website, and written communication to ensure accurate processing of claims . 15% + Follows established procedure for missing ... individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working across the… more
- University of Rochester (Albany, NY)
- …through telephone calls, payer website, and written communication to ensure accurate processing of claims . Collaborate with appropriate departments to generate a ... rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims... processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. +… more
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