- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …Expected to partner with necessary entities in order to effectively input, audit and adjust within the adjudication platform. **Job Summary:** Perform day-to-day ... resources within and external to ProAct as needed in order to input, audit , and adjust data within the adjudication platform. **Responsibilities** + Perform benefit… more
- Axis (New York, NY)
- …of key internal stakeholders (legal, finance, reinsurance, product, underwriting, operations, claims , etc.). * Lead engagement with MGA/program and key external ... and Underwriting Guidelines and keep them current. * Manage Underwriting File Audit and Underwriting File Inspection process, templates, and standards per the… more
- Molina Healthcare (Syracuse, 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
- Ankura (New York, NY)
- …Life Sciences sector in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act; Department of Justice ... and Health and Human Services Office of Inspector General guidance;...of industry experts with backgrounds in compliance, regulatory, legal, audit , operations, nursing, pharmacy, medical science, economics, accounting, and… more
- University of Rochester (Rochester, NY)
- …Counsel identifies, analyzes and provides legal guidance and services on complex health care regulatory and corporate matters relevant to the University of Rochester ... Medical Center (Medical Center) and its health care affiliates, including hospitals, long term care facilities,...the Anti-Kickback Statute, the Physician Self-Referral Law, the False Claims Act, Civil Monetary Penalties, and Medicare and Medicaid… more
- Datavant (Albany, NY)
- Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the ... time, in the right format. Our platform is powered by the largest, most diverse health data network in the US, enabling data to be secure, accessible and usable to… more
- Walgreens (Amherst, NY)
- …to medical provider as needed to ensure medication is taken correctly, health needs addressed, and satisfaction with service. + Performs pharmacist tasks including ... ways to further promote productivity. + Ensures the accurate processing of insurance claims to resolve patient issues and prevent payment rejections. Follows up with… more
- Walgreens (Peekskill, NY)
- …to medical provider as needed to ensure medication is taken correctly, health needs addressed, and satisfaction with service. + Performs pharmacist tasks including ... to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows- up with… more
- New York State Civil Service (Albany, NY)
- …grade nutrition requirements;* Evaluate and assess compliance with cost principals, audit requirements and Civil Rights requirements; * Monitor program payments for ... accuracy and timeliness;* Recommend necessary follow-up actions associated with claims and correspond with Reimbursement Unit to report irregularities; and* Assist… more
- Walgreens (Utica, NY)
- …to medical provider as needed to ensure medication is taken correctly, health needs addressed, and satisfaction with service. + Performs pharmacist tasks including ... to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with… more
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