• Senior Process Improvement Professional

    Humana (Albany, NY)
    …community and help us put health first** The Senior Process Improvement Professional , DSNP Encounters Data Management supports the Encounter Data Management team ... Reporting and Improvement organization (HQRI). The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes… more
    Humana (08/27/25)
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  • Clm Resltion Rep III, Hosp/Prv

    University of Rochester (Albany, NY)
    …individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working across the ... professional fee organization, handling follow-up activities designed to bring...open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum… more
    University of Rochester (08/07/25)
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  • Sr. Litigation Specialist, GL (Construction)

    Travelers Insurance Company (Melville, NY)
    …and resolving assigned Specialty Liability Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer ... not manage staff. **What Will You Do?** + Directly handles assigned severity claims . + Provides quality customer service and ensures quality and timely coverage… more
    Travelers Insurance Company (08/29/25)
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  • Major Case Specialist, Construction

    Travelers Insurance Company (Melville, NY)
    …evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life cycle ... **What Will You Do?** + Directly handle assigned severe claims . + Full damage value for average claim (without...addition, our mental health program provides access to free professional counseling services, health coaching and other resources to… more
    Travelers Insurance Company (08/14/25)
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  • Revenue Cycle Coordinator IV

    University of Rochester (Rochester, NY)
    …independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues that affect ... reimbursement of claims and advising the management team of those trends...will represent the department and the Hospital in a professional manner, protecting confidentiality of patient information at all… more
    University of Rochester (08/07/25)
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  • Professional , Quality Analyst

    MVP Health Care (Rochester, NY)
    …thinking and continuous improvement. To achieve this, we're looking for a ** Professional , Quality Analyst** to join #TeamMVP. This is the opportunity for you ... quality data highly preferred + Subject matter expertise in healthcare data- claims , coding, HIE's etc. Experience with quality metrics, (NCQA HEDIS and NYS… more
    MVP Health Care (08/30/25)
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  • Clm Resltion Rep III, Hosp/Prv

    University of Rochester (Rochester, NY)
    …judgment within department guidelines, the position is responsible for managing professional hospital accounts. Activities performed will focus on resolving balances ... independent decisions as to the processes necessary to collect denied insurance claims , no response accounts, and will investigate resolving billing issues. Maintain… more
    University of Rochester (08/07/25)
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  • Associate Director, Performance Analytics

    Evolent (Albany, NY)
    …CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing and ... + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to identify cost drivers, utilization patterns,… more
    Evolent (07/15/25)
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  • Medical Services Coordination Specialist I/II/III

    Excellus BlueCross BlueShield (Rochester, NY)
    …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
    Excellus BlueCross BlueShield (08/27/25)
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  • Revenue Specialist

    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 ... are not limited to:** + Prepare and submit hospital claims . Review denials. Investigate coding issue. Audits. + Follow-up...electronic reference check with a minimum of three (3) professional references. + Successfully complete a 4 panel drug… more
    Stony Brook University (07/08/25)
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