- Molina Healthcare (Yonkers, NY)
- …of business as it relates to audits. * Delegation Oversight; voting representative for delegation oversight committees. * Liaison to Special Investigative Unit ... 5 years of experience in Medicare, DSNP and CSNP population, Enrollment, A&G, Claims , Compliance, or other Operations experience To all current Molina employees: If… more
- University of Rochester (Rochester, NY)
- …unpaid accounts, check claim status on appropriate payer systems or contact an insurance representative to obtain information as to why claims are not paid and ... 7:30 AM-4 PM Responsibilities Location Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... place where all can thrive. **Job Location (Full Address):** Remote Work - New York, Albany, New York, United...process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative … more
- University of Rochester (Rochester, NY)
- …Payer Website link (EPIC Insurance Coverage tab), review payer website, or contact payer representative as to why claims are not paid. + Determines steps ... independent decisions as to the processes necessary to collect denied insurance claims , no response accounts, and will investigate resolving billing issues. Maintain… more
- Canon USA & Affiliates (Albany, NY)
- …and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business, ... expertise, and reviewing study/test-plan design. Influence regulatory specifications and claims strategy by providing clinical consultation during early phase… more
- Humana (Albany, NY)
- …across the department. **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & ... skills to make an impact** **WORK STYLE:** Work at home/ remote with 15-20% travel required **WORK HOURS:** Regular business...Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of… more
- Pfizer (Pearl River, NY)
- …expertise in common types of commercially available RWD in the US, including closed claims , open claims , structured EHR, unstructured EHR, linked claims + ... outcomes and create business impact. + Work Location Assignment: Hybrid / Not Remote + Relocation Support Possible The annual base salary for this position ranges… more
- EFI Global (New York, NY)
- …client relationships, and collaborate closely with internal/external stakeholders. This remote role includes regular travel for in-person meetings and events, ... of experience and education required to include three (3) years as an Account Representative **OR** five (5) years adjuster experience including one (1) year in a… more
- Sumitomo Pharma (Albany, NY)
- …and Drug Administration's implementing regulations, the Federal Anti-Kickback Statute, the False Claims Act, PhRMA, Corporate Code of Business Conduct and the Office ... General's Compliance Program Guidance for Pharmaceutical Manufacturers. + The specialty representative role will require territory coverage of a potentially large… more
- Arnot Health (Elmira, NY)
- …+ Full-time, salaried, exempt role + Monday through Friday + Day Shift + Remote What You'll Do: + Review new procedures to determine coverage and reimbursement ... payer policies) + Assist in claim edit resolution to ensure compliant, clean claims are submitted + Maintain proficiency in CPT, HCPCS, ICD-10, OPPS, and related… more