- Mount Sinai Health System (New York, NY)
- …and executive-facing roles ? Advanced analytical capabilities required, experience with healthcare claims analysis and clinical quality measures highly preferred ... finance and strategic business needs (eg, market sizing), and healthcare topics (eg, claims analysis) with guidance...(eg, market sizing), and healthcare topics (eg, claims analysis) with guidance from Quality Director ? Effective… more
- City of New York (New York, NY)
- …obligations, regulatory requirements, and internal policies related to the payment of daily healthcare claims and monthly administrative fees. 2. Claims Data ... Validation: Verify the accuracy, completeness, and timeliness of daily healthcare claims payment data submitted by the health plan prior to authorize payment.… more
- Highmark Health (Albany, NY)
- …efforts. Daily responsibilities will involve the in-depth analysis of complex healthcare claims data utilizing advanced analytical techniques to detect ... analytical strategies. - Develop and optimize SQL queries to extract data from healthcare claims databases. - Analyze large datasets of healthcare claims … 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
- Evolent (Albany, NY)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Molina Healthcare (NY)
- JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Molina Healthcare (NY)
- …**Job Summary** Respond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, ... and researching, investigating and ensuring appropriate resolution of claims . **Knowledge/Skills/Abilities** + Responds to incoming calls from providers regarding … more
- Molina Healthcare (Yonkers, NY)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Molina Healthcare (Buffalo, NY)
- …Job Summary Respond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, and ... researching, investigating and ensuring appropriate resolution of claims . **Essential Job Duties** * Responds to incoming calls from providers regarding claims … more
- Molina Healthcare (Syracuse, NY)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise,… more