- Trustmark (Albany, NY)
- …communities. **About the role** This role is a dedicated training position for Claims that resides in the Knowledge Management & Customer Experience group. The ... primary function of this role is to train and audit new and existing staff in all products including...claim handling process and procedures and experience in handling claims appropriately in accordance with the corporate claim philosophy,… more
- Independent Health (Buffalo, NY)
- …of Independent Health policies and procedures. + Prepare and present audit results as needed, to various levels of internal senior leadership for approval ... will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing,… more
- Highmark Health (Buffalo, NY)
- …Guarantees and other operational quality process improvement efforts. Maintains accurate audit documentation and is required to follow appropriate audit ... and systems within the process being audited. Manage individual inventory of audit work to meet department quality standards. Participate in special project work… more
- Independent Health (Buffalo, NY)
- …seminars and/ or content to all primary care practices associated with Independent Health . The Analyst is responsible for the targeted delivery of information to ... The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification...verify CMS HCC submission as assigned per CMS RADV audit specifications. The Analyst is going to assist the… more
- Highmark Health (Albany, NY)
- …This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Highmark Health (Albany, NY)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Highmark Health (Albany, NY)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... audit activities. Reviews medical records to determine data quality...of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines.… more
- Kaleida Health (Buffalo, NY)
- …(DRG) assignment, proper reimbursement and quality measure/metrics. Assists with the audit analysis, trending, and presentation of audit /review findings, ... plan and execute quality audits, perform data analysis, trending, presentation of audit /review findings, and identify opportunities and develop a training plan for… more
- Independent Health (Buffalo, NY)
- …system administration and reporting, vendor delegation oversight, medical pharmacy claims processing and training. They will establish and monitor performance ... + Accountable for development and production of regulatory reporting to meet/exceed audit requirements. + Accountable for business need reporting to track metrics,… more
- Zurich NA (New York, NY)
- Chief Auditor - Zurich Cover-More 123124 **About Us** **Zurich Group Audit ** Zurich Group Audit is a diverse international team of over 250 colleagues from 33 ... has a global remit and will be responsible for assessing and executing audit activities related to the global integration as well as designing and implementing… more