- Humana (New York, NY)
- …higher quality and operational efficiency. + Ensure enrollment and claims processes comply with regulatory requirements and guidelines. + Partner with ... Enrollment Period (AEP). + Utilize tools such as Availity to streamline claims submission, eligibility verification, and authorization processes. + Directly lead a… more
- CVS Health (Albany, NY)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... Pharmacy Payment Compliance reporting using SQL and SAS. You will continuously improve quality controls and accuracy of reported data, looking for ways to further… more
- Mount Sinai Health System (New York, NY)
- …Sinai is one of the largest US health systems with a strong reputation for quality of care and research. We have over 38,000 employees working together to provide ... billions of dollars in high- quality care each year for millions of patients. We...In-depth knowledge of healthcare revenue cycle processes, including billing, claims management, and payment reconciliation. + Familiarity with **Stratajazz**… more
- Molina Healthcare (Albany, NY)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases...supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other… more
- Humana (Albany, NY)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root causes driving issues and… more
- Sedgwick (Albany, NY)
- …disclosures, and state-level insurance regulations + Participate in coaching, quality reviews, and process improvement initiatives **ADDITIONAL FUNCTIONS and ... + Performs other duties as assigned. + Supports the organization's quality program. **QUALIFICATIONS** + Active Property & Casualty or Personal Lines… more
- EFI Global (Rochester, NY)
- …and environmental services teams around the world share a dedication to expertise, quality and demonstrating to customers that caring counts(R). Each of our more ... + Performs other duties as assigned. + Supports the organization's quality program(s). + Travel as required. **SUPERVISORY RESPONSIBILITIES** + Administers company… more
- Outreach Development Corporation (Richmond Hill, NY)
- …from substance use and behavioral health disorders by providing the highest quality , life-changing treatment, training and tools to build healthy lives. Our mission ... a life of unlimited potential by developing and delivering the highest quality evidence-based behavioral health services and training. For more information, please… more
- MTA (New York, NY)
- …and refactoring programs/scripts and integration software services, and maintaining high- quality software to meet business and customer needs. Software Engineers ... a highly experienced Systems Engineer with relevant experience across claims , insurance, enterprise safety and security systems, occupational health services,… more
- Latham, The Pool Company (Latham, NY)
- …North America, Australia, and New Zealand, we are committed to delivering innovation, quality , and sustainability in everything we do. We believe in building an ... communicates with homeowners and dealers regarding warranty/ non warranty items ( claims , repairs, inquiries, etc.). This manager will handle escalations from… more