- CVS Health (NY)
- …we do it all with heart, each and every day. Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the ... member satisfaction and retention by providing accurate and timely resolution in processing medical claims . You will be a key link in providing our customers… more
- CVS Health (NY)
- …regulations, and security requirements. **Required Qualifications** + 1 year minimum of claims processing experience + Experience with system testing and post ... go-live validation + QNXT Experience + Familiarity with clinical and code editing concepts and products (Example: ClaimsXten, Cotiviti PPM & CV) + Extensive knowledge of CPT, HCPCS, ICD-10 coding **Preferred Qualifications** + Prior Relevant Work Experience… more
- Humana (Albany, NY)
- …Qualifications** + Associate's or Bachelor's Degree + Previous experience in medical claims processing + Grievance and appeals experience + Medical terminology ... experience + Prior experience with Medicare + Ability to manage large volume of documents including tracking, copying, faxing and scanning + Excellent interpersonal skills with ability to sensitively and compassionately interact with geriatric population… more
- Albany Leadership (Albany, NY)
- …applicable laws. ? Process Annual FRPL forms and input into the system ? Monthly CN Claims processing ? Assist in ordering and prepping all School event meals ? ... Perform special assignments and other duties as assigned or required by the supervisor. Desired Skills: ? Ability to complete 10 hours of training annually as required by the USDA. ? Experience in quantity food production and preparation preferred. ? Must be… more
- Humana (Albany, NY)
- …Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a ... corporate environment and understanding of business operations + Bilingual in Spanish **Additional Information** **Work at Home Requirements** * At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL… more
- Northern Rivers Family Services (Queensbury, NY)
- …and Medicaid Services (CMS). All electronic prescriptions in NYS require an NPI. Claims processing functions also require the NPI of nurse practitioners and ... physicians. + Federal Drug Enforcement Administration (DEA) number - issued by the United States Department of Justice Department DEA to nurse practitioners and physicians to prescribe controlled substances. DEA registration must be renewed every three years… more
- Baylor Scott & White Health (Albany, NY)
- …environment in a work environment. + Knowledge of healthcare and health insurance claims processing domains. + Ability to write complex SQL queries against ... relational databases. + Must possess excellent documentation and communication skills. + The ability to understand, model, and interpret data. + Accuracy and attention to detail. + Must possess good social skills. + Excellent written and verbal communication… more
- Molina Healthcare (Syracuse, NY)
- …health care operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) * Advanced understanding on health care ... financial terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as… more
- Mount Sinai Health System (New York, NY)
- …* Drive the revenue cycle processes for bundle payment operations including claims processing , payment receipt, and payment distribution in collaboration with ... the revenue cycle team. * Drive the implementation and iteration of new technologies to support day-to-day operations (eg, ZenDesk). * Develop and maintain documentation for product operations, including standard operating procedures and training materials. *… more
- Public Consulting Group (Albany, NY)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... Cost Allocation Plans and Time Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets A Test Leader oversees the testing process, developing test strategies and plans, guiding a team of testers, and collaborating with… more