- 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
- 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 (Albany, NY)
- …Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, ... likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… 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
- Molina Healthcare (Buffalo, NY)
- … healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms ... related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… 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
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …Assist in billing and cash application of Medicaid/Medicare/DME/Home Infusion claims . Manage open accounts receivable which requires rebilling within timely ... and payment application for secondary insurances, Noble Medical Billing Claims , home infusion claims , and DME ...as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides… more
- Molina Healthcare (NY)
- …SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information ... enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims… 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