- Northwell Health (Garden City, NY)
- …insurance and collects additional insurance such as No Fault and Workers Compensation . + Performs financial assessment of patients; refers potential Medicaid cases ... Summary: Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and… more
- Humana (New York, NY)
- …operations for 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
- Humana (Albany, NY)
- …problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity ... for Medicare/Medicaid claims errors. **Key Role Functions** + Develop business processes...be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
- Guidehouse (New York, NY)
- …client business problems, which include but are not limited to medical and pharmacy claims (open and closed), formulary and managed care data, and EMR data. + ... Ability to work with large data sets such as claims data. + Excellent attention to detail and ability...The annual salary range for this position is $118,000.00-$196,000.00. Compensation decisions depend on a wide range of factors,… more
- Humana (Albany, NY)
- …an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... researching medical claims + Proficient in Microsoft Office (Word, Excel, Access,...be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… 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 ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… 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 ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Molina Healthcare (Albany, NY)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims , Provider Services and Contracting. * Identifies issues, resolves problems… more
- Sedgwick (Albany, NY)
- …at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job ... postings. Actual compensation is influenced by a wide range of factors...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Evolent (Albany, NY)
- …- Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in ... assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable experience with Testing, Writing Test cases, Test Plans,… more