• Manager, Claims Operations & Research

    Molina Healthcare (Yonkers, NY)
    **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
    Molina Healthcare (06/07/25)
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  • Claim Appeals And Audit Specialist

    CenterLight Health System (NY)
    …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical...Education: Bachelor's degree required. Experience: + 1-3 years of healthcare experience, managed care setting is strongly preferred. +… more
    CenterLight Health System (04/26/25)
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  • Claims Implementation Analyst

    Healthfirst (NY)
    …of Medicare and Medicaid programs and reimbursement methodologies a plus. + Knowledge of healthcare claims processing practices in a managed care setting a plus. ... before sign-off and Production. + Assist in the on-going audit of configurations for new and existing claims...Qualifications:** + Managed care, commercial health plan (or other healthcare related) experience where you have performed claim or… more
    Healthfirst (05/29/25)
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  • Claims Analyst

    CenterLight Health System (NY)
    …a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes, conducting comprehensive data analysis, ... guidelines. This position requires a working knowledge of Government Programs medical claims payment system and configuration with strong focus on data review and… more
    CenterLight Health System (04/26/25)
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  • Claims Auditor

    Centers Plan for Healthy Living (Staten Island, NY)
    Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
    Centers Plan for Healthy Living (04/15/25)
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  • Assoc Analyst, Provider Config

    Molina Healthcare (NY)
    …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... timely manner to meet department standards of turnaround time and quality. + Audit loaded provider records for quality and financial accuracy and provide documented… more
    Molina Healthcare (05/03/25)
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  • Clinical Appeals Nurse (RN)

    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
    Molina Healthcare (05/16/25)
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  • Senior Benefit Operations Specialist

    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
    KPH Healthcare Services, Inc. (04/18/25)
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  • Special Education Teacher

    Genesis Healthcare (Hauppauge, NY)
    …within the Compliance and Ethics Program, Standard/Code of Conduct, Federal False Claims Act and HIPAA. 2. Participates in required orientation and training ... Officer via the Integrity Hotline. 4. Cooperates with monitoring and audit functions and investigations. 5. Participates, as requested, in quality assurance… more
    Genesis Healthcare (03/21/25)
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  • Licensed Behavior Analyst

    Genesis Healthcare (Roosevelt, NY)
    …within the Compliance and Ethics Program, Standard/Code of Conduct, Federal False Claims Act and HIPAA. 2. Participates in required orientation and training ... Officer via the Integrity Hotline. 4. Cooperates with monitoring and audit functions and investigations. 5. Participates, as requested, in quality assurance… more
    Genesis Healthcare (03/21/25)
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