- CVS Health (Albany, NY)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Sanofi Group (Albany, NY)
- …and assisting in patient pull though efforts. We are an innovative global healthcare company, committed to transforming the lives of people with immune challenges, ... requirements, buy & bill processes, billing and coding education, claims and adjudication by site of care, financial assistance...of Sanofi T1D products by health care providers and/or healthcare facilities. + Act as the main point of… more
- Anthony Jordan Health Corp (Rochester, NY)
- …ensure: . Risk identification and incident management . Proactive risk reduction and claims prevention . To manage and encourage ongoing education of Jordan Health ... And Experience Required: . Bachelor's degree in Health Care Sciences ie Healthcare Administration, Nursing (BSN), Public Health or Business Administration. . Minimum… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …Balance and Subrogation Recoveries ensuring all recoveries received are processed by claims department and then appropriately accounted for and returned to clients. ... our people are committed to the improvement of how healthcare is accessed and delivered. When you join our...and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services.… more
- Humana (Albany, NY)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance… more
- Highmark Health (Albany, NY)
- …and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality of ... to identify, develop and/or monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of care, efficiently and… more
- Independent Health (Buffalo, NY)
- …basis. Assist in interpreting database information as it relates to pharmacy claims processing. + Assist with PBM implementation by identifying potential issues and ... with various data entry projects/information as they relate to pharmacy claims processing. C. Administrative Duties + Provide accurate and up-to-date information… more
- Catholic Health Services (Melville, NY)
- …are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Position ... himself/herself in conformity with the CHS Security policies and procedures. Analyze claims data with the goal of identifying and quantifying payment issues and… more
- FlexStaff (Chappaqua, NY)
- …and a chance to be part of a dedicated team committed to high-quality healthcare administration. Under the direct supervision of a Senior Team Lead, the Accounts ... and patients by telephone or online and appealing denied or incorrectly paid claims . Key Responsibilities: - Review insurance payments for accuracy based on fee… more
- The Wesley Community (Saratoga Springs, NY)
- …for all payer types. + Monitor and maintain aging reports for outstanding claims . Respond to and resolve insurance claims denials, rejections, and underpayments ... Private insurance. + Experience with Private Pay collections. + Experience with Healthcare billing software Point Click Care (PCC) preferred. + Experience with… more