- Humana (Albany, NY)
- …Qualifications** + Bachelor's degree + Advanced degree or MBA + Comprehensive knowledge of EDI formats: X12, 834, 835, 837, 270/271, 276/277, 278 + Current or recent ... experience in a large, highly matrixed company + Prior health insurance industry experience **Additional Information** **Work-At-Home Requirements:** + WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.… more
- Cognizant (Albany, NY)
- …claim processing system and comparing with corresponding UB or HCFA paper or EDI information. * Responsible for reviewing medical records when necessary to determine ... if service rendered was medically appropriate and criteria have been met. * Responsible for reviewing claim and line-item edits and warning messages for determination of whether to pay claim/line item(s). * Ensuring all designated tasks are handled within the… more
- Cognizant (Albany, NY)
- …system (Facets) and comparing it with the corresponding UB, HCFA paper, or EDI information. + Responsible for reviewing medical records when necessary to determine ... if the service rendered was medically appropriate and criteria has been met. + Responsible for reviewing claim and line item edits and warning messages for determination of whether to pay claim/line item(s). + Ensure that all designated tasks are handled… more
- Parker Hannifin Corporation (Clyde, NY)
- …software and specialized purchasing and/or materials systems (eg electronic data interface ( EDI ) or manufacturing resource planning (MRP) systems). + Ability to work ... on a variety of problems of diverse scope and complexity where analysis and evaluation of various outcomes require trade-offs. + Ability to solve a wide range of difficult problems in imaginative and practical ways and evaluate alternative solutions that may… more
- Molina Healthcare (New York, NY)
- …regulatory-related, Molina Quality programs, and taking advantage of electronic solutions ( EDI , EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other ... Provider Relations Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.) **Job Qualifications** **REQUIRED EDUCATION** : Bachelor's Degree… more
- Centene Corporation (Queens, NY)
- …and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics + Perform provider orientations and ongoing provider ... education, including writing and updating orientation materials + Manages Network performance for assigned territory through a consultative/account management approach + Evaluates provider performance and develops strategic plan to improve performance + Drives… more
- Humana (Albany, NY)
- …(Word, Excel, Access, PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats (837P/I/D, 999, 277, 835, 270/271, 834) + Demonstrated ability to ... identify process gaps and recommend solutions independently + Self-directed with initiative to drive projects and escalate issues appropriately + Strong analytical skills with experience resolving complex data issues + Proven decision-making in ambiguous… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …in this position. + Knowledge and experience with working with and setting up EDI files, 834/837 files and SFTP sites. + Excellent verbal and written communication ... skills. + Ability to maintain effective relationships with internal and external project resources. + Ability to work autonomously in performing duties requiring extensive knowledge and understanding of the healthcare industry and project management. + Must… more
- City of New York (New York, NY)
- …software to ensure accuracy following CMS and other third-party insurance guidelines.- - Monitor EDI denials in a timely manner. - Prepare and batch claims out to ... third party payers for reimbursements. - Review clearinghouse acceptance and rejection reports. - Edit and make correction to rejected claims and re-batch to third party payers. - Monitor aging accounts receivable reports (A/R) and provide feedback to… more
- Amazon (New York, NY)
- …and delivery lead-times, while optimizing operational excellence inputs such as EDI adoption, PO confirmations, efficient receive processes, and inventory placement. ... - Spearheading initiatives to enhance cost structure and profitability, collaborating closely with partner teams to ensure successful execution. About the team About the team: The Amazon Vendor Services program is a paid service that offers enrolled Selling… more