- Healthfirst (NY)
- …of teamwork and collaboration + Complement the broader team with high quality and partnership + Communicates effectively with internal stakeholders to identify needs ... contract reimbursement terms, code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …goals established for the position in the areas of: efficiency, call quality , provider satisfaction, first call resolution and attendance + Continuously evaluate and ... health plan choices they need for healthy living. CPHL is committed to providing quality , coordinated health care to some of the most honored and yet still… more
- Molina Healthcare (Yonkers, NY)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Centene Corporation (Queens, NY)
- …years of managed care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations. ... for issue resolution. Drive optimal performance in contract incentive performance, quality , and cost utilization. + Conducts regular in-person visits with physicians… more
- MetLife (Oriskany, NY)
- …Responsibilities: * Conducts quality reviews of Americans with Disabilities Act (ADA) claims . * Identifies trends, root causes, and quality gaps from the ... timely and meaningful feedback to associates and management regarding performance and quality standards. * Partners with team to develop criteria and standards in… more
- Centene Corporation (New York, NY)
- …of recommendations to providers that would improve utilization and health care quality . + Reviews claims involving complex, controversial, or unusual or ... a leading provider of government-sponsored healthcare coverage, providing access to affordable, high- quality services to Medicaid and Medicare members, as well as to… more
- Centene Corporation (New York, NY)
- …of recommendations to providers that would improve utilization and health care quality . + Review claims involving complex, controversial, or unusual or ... pharmacy, case management, disease management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to… more
- Two95 International Inc. (New York, NY)
- …navigate and do the analyses * Lead the analytical-interrogation of their EMR/EHR and/or claims data to perform data quality checks * Partner with our ... * Lead the discovery of the client's EMR/EHR and/or claims data environment so we can efficiently and effectively...similar * Deep familiarity with HEDIS & CMS care quality measures; experience implementing both HEDIS and CMS measures… more
- CVS Health (Albany, NY)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality , or other concerns ... and appeals. **In this role, you will:** + Handle quality checks for the appeals team, in order to...PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior… more
- Rochester Regional Health (Rochester, NY)
- …limited to, health care data systems, electronic medical records, paid claims , and national/regional benchmarks. The Quality Informatics Analyst-Senior analyzes ... Job Title: Quality Informatics Analyst - SeniorDepartment: Quality Informatics SUMMARY: The Quality Informatics Analyst-Senior is responsible for data… more