- Molina Healthcare (Buffalo, NY)
- …+ Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Mount Sinai Health System (New York, NY)
- …or HS Diploma/GED plus two years of related experience. + 3 years of health claims billing experience; prefer experience working with CPT and ICD-10 coding ... Us** **Strength through Unity and Inclusion** The Mount Sinai Health System is committed to fostering an environment where...next chapter in our history. **About the Mount Sinai Health System:** Mount Sinai Health System is… more
- Robert Half Accountemps (Syracuse, NY)
- …placement role, you'll be a key player in managing billing operations for Home Health Care services, ensuring timely and accurate claims processing and payment ... reconciliation. What You'll Do: Review and verify Home Health Care claims for accuracy and completeness. Submit claims and invoices to payors/clients… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... general supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory… more
- Molina Healthcare (Yonkers, NY)
- …+ Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including ... cases to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises… more
- Mount Sinai Health System (New York, NY)
- …The ideal candidate will have had some experience working with health administrative/insurance claims data and/or other large datasets. **Qualifications** ... and Data Science, the Department of AI and Human Health , and the Center for Child Health ...precision medicine. We leverage causal learning to analyze administrative claims data, medical records, and clinical trial data, while… more
- Highmark Health (Buffalo, NY)
- …3 years of Working knowledge of medical procedures and terminology + 3 years of Health Care claims , Health Insurance and Benefit Administration **SKILLS** ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice… more
- Amentum (Albany, NY)
- …algorithms to detect anomalous billing trends and patterns. + Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS, Business ... entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns....matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems. + Working knowledge… more
- MetLife (New York, NY)
- …use of OCR, NLP and LLMs, and building a brand-new ontology for animal health claims . * Governance and data expertise: Establish governance frameworks for data ... roadmap for Pet, aligned with business objectives and enterprise data strategy. * Claims automation: Given the exponential growth of the Pet business, claims … more
- Independent Health (Buffalo, NY)
- …benefit managers, and other insurance companies to accurately identify Independent Health responsibility for primary claims payment. Technical Proficiency and ... Innovation + Retain technical knowledge of Independent Health 's customer documentation and claims processing systems to review and maintain member records, as… more
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