- City of New York (New York, NY)
- …Bureau and the case docket will consist of cases in housing, employment, healthcare and public accommodations. - Interview members of the public alleging claims ... pre-complaint interventions, investigations, and file complaints where appropriate. - Investigate claims of discrimination made by members of the public and pattern… more
- Highmark Health (Albany, NY)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... industry regulatory changes and assess their potential impact on Claims Operations, Customer Service and other operational areas processes...Health Insurance Industry + 3 - 5 years the Healthcare Industry + 3 - 5 years in Lean/Six… more
- BronxCare Health System (Bronx, NY)
- Overview Conduct review of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. In-service staff ... collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role The ideal candidate is an experienced program manager with healthcare payer / TPA experience who excels in client interaction and can effectively ... planning, directing, and coordinating complex product/program implementation in the HealthCare Payer domain and or Third-party Administration of self-funded clients… more
- Walgreens (Tonawanda, NY)
- …the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Evolent (Albany, NY)
- …Be Doing:** Job Description **Analyst, Integration Quality** Integration testing in the healthcare ecosystem requires complete end to end testing in the specialty ... work experience + General knowledge of data flow and healthcare end to end system landscape + Good knowledge...Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1… more
- Guidehouse (New York, NY)
- …client business problems, which include but are not limited to medical and pharmacy claims (open and closed), formulary and managed care data, and EMR data. + ... to IQVIA, Komodo, Compile, MMIT/Norstella, Symphony Health, Truven/Merative, and Definitive Healthcare . + Lead internal and external discussions to understand and… more
- Humana (Albany, NY)
- …an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... researching medical claims + Proficient in Microsoft Office (Word, Excel, Access,...strong relationship-building and stakeholder engagement skills + Familiar with healthcare industry regulations or adjacent sectors **Preferred Qualifications** +… more
- Walgreens (Delhi, NY)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- CVS Health (Amherst, NY)
- …interpretation, and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for ... and systematic setup essential to the processing of our claims adjudication system. The setup must also align for...align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level… more