- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …monthly, quarterly, and annual management reports for PBM clients, and from our Claims Processor. + Assist with on-site client orientation, health fairs and business ... conferences. + Assist with on-site resolution of customer service issues to clients. + Performs office duties as needed (includes copying, collating, mailings, filing) + Responsible for completing all mandatory and regulatory training programs + Facilitate and… more
- Mount Sinai Health System (New York, NY)
- …in clinical, revenue cycle & encounter data models. + Extensive knowledge of healthcare /medical data such as hospital/physician claims , utilization data, and ... Masters preferred. + 7 years of progressively responsible experience in healthcare analytics or revenue cycle operations. Essential skills include strong analytical,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Essential Accountabilities: Level I . Analyzes and audits acute inpatient claims . Integrates medical chart coding principles, clinical guidelines, and objectivity in ... Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform. . Manages case volumes and review/audit schedules,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... case for clinical staff. + Navigates and utilizes corporate applications; core claims and membership system, intranet and related links to provide support to… more
- American Endovascular & Amputation Prevention LLC (New York, NY)
- …explain medical terminology. + Coordinate care with physicians, nurses, and other healthcare professionals. + Handle billing and insurance claims ; resolve ... This role is ideal for someone who thrives in a fast-paced healthcare environment, enjoys helping others, and can communicate fluently inEnglish and Spanish.… more
- Highmark Health (Albany, NY)
- …CrewAI) and Generative AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management, claims processing, member ... cutting-edge applications of Generative AI (GenAI) and Agentic AI within the healthcare payer domain. The intern will work alongside AI Engineers, Data Scientists,… more
- Stony Brook University (East Setauket, NY)
- …support day-to-day business functions including but not limited to: billing, claims analysis appeals, follow-up, financial assistance and customer service. **Duties ... are not limited to:** + Prepare and submit hospital claims . Review denials. Investigate coding issue. Audits. + Follow-up...minimum of 6 months business experience, preferably in a healthcare setting;OR an Associate's degree and at least 6… more
- Mount Sinai Health System (New York, NY)
- **Job Description** Responsible for ensuring unpaid and partially paid claims are resolved in an efficient and timely manner. Resolves EOB discrepancies and ... plus two years of related experience. + 2 years healthcare billing experience required. Familiarity with CPT and ICD...CPT and ICD (coding and CCI edits) + Electronic claims processing preferred. **Responsibilities** 1. Follows up on submitted… more
- Humana (Albany, NY)
- …**Preferred Qualifications** + Bachelor's Degree + Prior experience working within the healthcare field + Previous experience with medical claims + Project ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- Helio Health Inc. (Syracuse, NY)
- …of Medicaid and Third-party claim procedures for both paper-based and electronic claims . + Strong understanding of healthcare regulations, including HIPAA and ... + Other duties as assigned. Qualifications + Associate's degree in healthcare administration, business administration, or a related field required. Bachelor's degree… more