- Evolent (Albany, NY)
- …analyses into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based ... RVUs, bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing… more
- Cognizant (Albany, NY)
- …claim processing is required. **Travel:** None required **About the role:** As Claims Adjudication Specialist, you will be responsible for timely and accurate ... adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support...* Good skills at problem resolution specifically related to healthcare claim adjudication. * Possess ability to work at… more
- Molina Healthcare (Yonkers, NY)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (Albany, NY)
- …trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- General Dynamics Information Technology (Menands, NY)
- …Trust/Other Required:** None **Job Family:** Professional Engineering **Skills:** Healthcare Claims ,Quality Assurance (QA),Structured Query Language (SQL) ... DB2 table relationships + REQUIRED SKILLS AND ABILITIES: + Experience with healthcare claims of all types; including 837 (I, D and P) transactions +… more
- CVS Health (Albany, NY)
- …. 3+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party ... . 5+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party … more
- New York eHealth Collaborative (New York, NY)
- …to manage large and complex datasets (eg, master patient indexes, SPARCS, healthcare claims ). + Design, implement, maintain, and enhance data workflows, ... with the New York State Department of Health to improve healthcare by collaboratively leading, connecting, and integrating health information exchange across… more
- Evolent (Albany, NY)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... public health, biology) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care,… more
- Amentum (Albany, NY)
- …research on individuals, business entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns. + ... trends and patterns. + Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS,...briefings and written reports to AUSAs on findings from healthcare data analytics. + Support development of internal best… more
- Evolent (Albany, NY)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more