- Excellus BlueCross BlueShield (Rochester, NY)
- …Bachelor's degree with a minimum of two years' experience in long term care insurance claims processing . + Must have the ability to review and interpret medical ... Insured, Insured's family, care providers, and adjudication of the claims . All work is directed under the terms and...appropriate plan of care for Insured in conjunction with health care personnel at the physician office, hospital, home… more
- CVS Health (New York, NY)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...of mathematical analysis methods, including predictive analytics, natural language processing , reinforcement learning and causal inference with in-depth specialization… more
- Highmark Health (Albany, NY)
- …(AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must ... + 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** +...in Financial Analysis in an acute care hospital or health insurance setting + 1 year in professional billing,… more
- Rochester Regional Health (Rochester, NY)
- HOW WE CARE FOR YOU At St. Lawrence Health , we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, ... We're not just a hospital; we're a beacon of health and wellness in the North Country. We proudly...etc. + Prepares and submits in a timely manner claims . Submission is made in compliance with DRG regulations… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …datasets from IQVIA, Symphony, Market Access Data (ie patient longitudinal data, claims data, distribution, sales, demand, promotion, formulary) + Strength in one or ... tools such as MicroStrategy, PowerBI, etc + Experience in processing , analyzing, and synthesizing various data sources (syndicated, specialty...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- FLACRA (Newark, NY)
- …FLACRA's billing and payment collection processes. This position is responsible for processing claims , managing accounts receivable, and ensuring timely and ... up on outstanding balances. + Work with insurance companies to address disputed claims and resolve processing issues. + Maintain and update tracking spreadsheets… more
- Intermountain Health (Albany, NY)
- …of clinical pharmacy services to members and affiliated providers. **Select Health Pharmacy Coordinator - Remote Position** This position requires rotating holiday ... call scheduling. **Job Essentials** + Provides clinical pharmacy support for Select Health and affiliated members. + Develops and implements innovative programs that… more
- Catholic Health (Buffalo, NY)
- …and/or require follow up action based on a payer denial. (4) Active engagement and processing of denied claims or other rebill efforts for follow up or ... and Home Care. The position will support the Catholic Health Infusion Pharmacy, Retail/Oral Pharmacy and Home Care and...regulations as well as the standards established by Catholic Health . Responsibilities will include, but are not limited to,… more
- Molina Healthcare (Syracuse, NY)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
- Walmart (Williamsville, NY)
- …by ensuring proper policies and procedures are followed Ensures the timely processing of claims forexample damaged defective returned liquidated items and ... Manages facilitylevel training and execution of asset protection safety and claims and receiving procedures by reviewing the application of policiesprocedures… more