- Mount Sinai Health System (New York, NY)
- …processes, and related regulations. ? Familiarity with contract terms, NYS regulations, claims processing , and healthcare reimbursement models. ? Experience in ... Description** Mount Sinai is one of the largest US health systems with a strong reputation for quality of...to ensure proper interpretation and application of terms during claims processing . * Ensure that all contract… more
- CVS Health (Albany, NY)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... At CVS Health , we're building a world of health...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… more
- Healthfirst (NY)
- …the investigation, determination and reporting of financial processes _specifically around Healthcare Claims Adjudication and Claims Processing_ + Ability ... staff. + Complete subsequent auditing and handling of specific claims and appeal requests including processing where...lines of business such as NY Medicare, Medicaid, Family Health Plus, Child Health Plus WE ARE… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …standards. Perform compliance and monitoring assessments to identify exceptions to establish claims adjudication requirements for pre-EOB and after posting of ... administration.Required Experience:7+ years relevant professional level experience in a claims processing environment.Preferred Experience:Experience working in an… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …HCPCS, ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems, claims flow, adjudication process, system edits and display ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Highmark Health (Albany, NY)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent… more
- Humana (Albany, NY)
- …Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience ... - What it takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with… more
- Humana (Albany, NY)
- …CFE, AHFI) * Experience testifying in court * Understanding of healthcare industry, claims processing , and investigative process development * Experience in a ... **Become a part of our caring community and help us put health first** Humana is looking for an experienced Healthcare Investigator to join its industry leading… more
- Centene Corporation (Queens, NY)
- …implementation and optimization of health plan operations systems (eg, claims adjudication platforms, CRM tools). + Drive digital transformation initiatives ... Centene is transforming the health of our communities one person at a...related to operational areas. + Oversee day-to-day operations including claims processing , provider network management, member services,… more
- Molina Healthcare (Buffalo, NY)
- …+ Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education**… more