- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Two95 International Inc. (New York, NY)
- …research preferred (but not required) * 10+ years of experience in healthcare data analysis (including EMR/EHR, claims , eligibility and publicly available ... will meet their needs * Lead the discovery of the client's EMR/EHR and/or claims data environment so we can efficiently and effectively navigate and do the analyses… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Oracle (Albany, NY)
- …and predictive analytics. * Apply generative AI to synthesize insights from multi-modal healthcare data (eg, EHRs, imaging, claims , and demographics) to enhance ... Oracle Health Data Intelligence (HDI) is leading the charge in transforming healthcare with innovative data and AI solutions. We're seeking a highly skilled… more
- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION Job Summary Leads and manages team responsible for claims activities including reviewing and resolving member and provider complaints, and ... oversees necessary correspondence in accordance with regulatory requirements. * Ensures claims production standards set by the department are met. * Maintains… more
- Molina Healthcare (Syracuse, NY)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the… more
- Molina Healthcare (NY)
- …Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data ... among operational and claims systems and application of business rules as they...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (Buffalo, NY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- Humana (Albany, NY)
- …a related field, or equivalent work experience. + Demonstrated experience in claims analysis, payment integrity, or healthcare data analytics, preferably within ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Cognizant (Albany, NY)
- …Consulting experience, preferably with top consulting firms * Strong background in Healthcare industry, including health plans, claims , and provider operations * ... of payer functions and Medicaid plan implementations, including enrollment, billing, claims , care management, member portal, shopper tools, etc. **These will help… more