- Humana (Albany, NY)
- …Clinical Certifications, CPC, CCS, CFE, AHFI). + 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** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent… more
- Molina Healthcare (Rochester, NY)
- … of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication , state, NCQA and CMS policies/guidelines, and any other ... Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job… more