- Excellus BlueCross BlueShield (Rochester, NY)
- …set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address ... and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and providers to obtain… more
- Seton Education Partners (Bronx, NY)
- …Public Charter Schools Network. This position reports directly to the Elementary School Director of Student Services and is based in the Bronx, NY. About Seton ... meetings. Another key responsibility is to support the Elementary Schools Director of Student Services by recruiting related services professionals through… more
- Cognizant (Albany, NY)
- …accounts. . Maintain working knowledge of applicable health insurers' internal claims , appeals, and retro-authorization as well as timely filing deadlines and ... Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare,… more
- Elevance Health (Latham, NY)
- …+ Trains associates on all upskilling of customer service and claims to include providing professional medical service facility correspondence, usage of ... + As needed, participates in meetings with primary contractor and the FEP Director 's Office. + Manages day-to-day interactions and relationships. + Acts as a liaison… more
- New York State Civil Service (Albany, NY)
- …and health and safety activities. This position is assigned to the Contract and Claims Unit as the clerk responsible to ensure timely review and processing of ... needed basis. --Assist direct contract providers and counties with correcting invalid claims . --Prepare letters and/or communication via email to field office staff,… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …and consistent revenue flow for organization. + Checks clearinghouse, Availity, for any claims in error edits, corrects, and submits to payer timely. + Follow up ... is to be done bi-monthly on assigned controls to include corrected claims , appeals, phone calls, or provider rep assistance to assure any missing or incorrect… more
- New York State Civil Service (Endicott, NY)
- …responsible for the following;. Accept and process both original and continued claims for Unemployment Insurance. . Conduct telephone interviews with claimants in ... of certifying for benefits.. Determine the need for further fact-finding and place claims on hold pending further investigation. Work a variety of reports . Provide… more
- ConvaTec (Massapequa, NY)
- …prior to submission. + Follows up with insurance companies on unpaid or rejected claims . Resolves issues and resubmits claims . + Reads and interprets insurance ... billing duties as requested by the Billing Supervisor, Billing Manager, or Director of Billing. **Qualifications/Education:** + Must have a high school diploma,… more
- Catholic Charities of the Dioscese of Albany (Albany, NY)
- …through: + Assist employees in the benefits program enrollment and benefit claims processes + Maintain changes to the employee benefit platforms including employee ... for employee absences, employee leave request and workers compensation claims + Monitor the LOA email inbox for requests...questions to the appropriate Employee Benefits team member or Director of Human Resources + Creates and maintains employee… more
- Win (Women In Need) (New York, NY)
- …positive findings and recommend any necessary corrective actions. + Partner with the Director of Talent Acquisition to help inform and ensure that any new compliance ... and state agencies with respect to employment charges and claims + Partner with COE heads to gain a...investigate reports of employee misconduct, harassment, retaliation and other claims . + Provide advice and counsel to managers as… more