- University of Rochester (Rochester, NY)
- …to acquire necessary information and assembly of documentation necessary to submit claims to the patient's insurance for approval including prior authorization and ... with social services and case management on patient assistance. **Compliance and Quality ** + Remains professional, courteous and diligent in all interactions with… more
- CDPHP (Albany, NY)
- …member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York. ... The company values people, quality , innovation, and community, and its corporate culture supports...customers at all levels of authority + Understanding of claims and claims payments CDPHP salary ranges… more
- CVS Health (Amherst, NY)
- …interpretation, and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for ... review, interpretation, and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats… more
- Molina Healthcare (Yonkers, NY)
- …responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of ... regulatory compliance adherence (in conjunction with functional counterparts) and quality metrics. Accountable for offering innovative guidance and solutions to… more
- Ankura (Lexington, NY)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... you can expect to: . Demonstrate the highest degree of professionalism, ethics, quality , and integrity . Grow Ankura's Disputes & Economics Life Sciences Practice by… more
- AON (New York, NY)
- …satisfied; ensure all deadlines are met on a timely basis; ensure quality standards are maintained and handle projects independently and creatively. Grasp topics ... binders and policy documentation. + Ensure client, marketing and claims files are maintained in a timely fashion. +...all deadlines are met on a timely basis; ensure quality standards are maintained and handle projects independently and… more
- Evolent (Albany, NY)
- …trend selection/development, and estimation of Evolent's ability to reduce cost and improve quality + Leading a team in the analysis and interpretation of cost and ... public health, biology) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care, or related… more
- Mount Sinai Health System (New York, NY)
- …knowledge of a health care EMR such as Epic/Clarity, aCW, etc.; a payor claims system such as Facets, Amisys, etc.; or a hospital/provider system such as IDX, ... **Responsibilities** + Analyzes data requests using information technology, enrollment, claims , pharmacy, clinical, contract, medical management, financial, administrative and… more
- Molina Healthcare (Syracuse, NY)
- …Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at ... internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC… more
- Walgreens (Staten Island, NY)
- …to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. + Strictly adheres to the Walgreen Co. policy regarding Good ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more