- MetroPlusHealth (Brooklyn, NY)
- Position Overview The BH Claims Supervisor will oversee personnel involved in the adjudication of behavioral health-related medical claims . This position will ... MetroPlusHealth employees regarding the adjudication of complex, difficult, and non-routine claims for multiple lines of business. The incumbent will coordinate with… more
- MetroPlusHealth (New York, NY)
- …This position will work with our application vendors as well as Claims Operations, Utilization Management, Network Management, and other operational areas to ... functions performed by delegated vendor as it relates to benefit configuration, claims processing, provider setup and account payable system Manage activities and… more
- MetroPlusHealth (New York, NY)
- …do every day. Responsible for providing provider onboarding, training for claims and billing procedures, contract compliance, Product, medical management, and ... provider network through customer service including training, credentialing assistance, claims resolution and advocacy. Develops and provides a standard orientation… more
- MetroPlusHealth (New York, NY)
- …to ensure compliant operation Provide governance and oversight of Unpaid Claims Liability (UCL) processes, ensuring appropriate internal controls, policies, and ... oversight, including internal teams and external vendors, to ensure accurate claims validation, payment integrity, and adherence to organizational and regulatory… more
- MetroPlusHealth (New York, NY)
- …performing analysis and administrative support specifically to Salesforce (SF) for the Claims Department. Incumbent will triage new cases and route/reroute cases as ... other duties, as assigned by management. Required Education, Training & Professional Experience Bachelor's degree required. Minimum 3 years' health plan experience… more
- Stony Brook University (East Setauket, NY)
- …support day-to-day business functions including but not limited to: billing, claims analysis appeals, follow-up, financial assistance and customer service. **Duties ... the following, but are not limited to:** + Prepare and submit hospital claims . Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied… more
- MetroPlusHealth (New York, NY)
- …individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: ... security of sensitive information and files. Required Education, Training & Professional Experience Associate degree required. 2-5 years of health care experience… more
- MetroPlusHealth (New York, NY)
- …and leadership skills. Work Shifts 9:00AM-5:00PM Duties & Responsibilities Reviews daily claims reports of varying focuses across all lines of business to identify ... PowerPoint is required. Experience in the evaluation and interpretation of pharmacy claims data and other clinical data is preferred. Position requires excellent… more
- MVP Health Care (Schenectady, NY)
- …in New York State A minimum of three (3) years' experience in a professional coding environment or three (3) years' experience in auditing and/or reviewing, customer ... other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. Perform research using "best practices"… more
- Stony Brook University (East Setauket, NY)
- …but are not limited to:** + Develops staff work listing logic/strategy and claims resolution work flows. + Educates and trains new staff regarding departmental/unit ... and trends. + Assists in maintaining and creating payer report cards, claims tracking and management reporting as requested. + Assists management reporting and… more
