- 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)
- …+ 2 or more years of project leadership experience + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS measurement** ... bridges product ownership, data and software engineering, and regulatory healthcare data requirements, ensuring that data ingestion, transformation, and delivery… 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
- 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)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more
- US Physical Therapy (Uniondale, NY)
- …join our Garden City team! This role is essential in ensuring accurate claims management, timely collections, and smooth patient billing processes. **Why You'll Love ... and collaborative team environment + Stability with a well-established, expanding healthcare company + Opportunities for career growth in revenue cycle management!… more
- HUB International (Melville, NY)
- …self-motivated individual who will serve as an Account Executive on our Healthcare Solutions team. **Responsibilities** : + Ongoing service and communication with ... brokerage and client service efforts with captive management, actuarial, claims and loss prevention as required. + Working with...existing & prospective clients. + Responsible for managing the claims process - working closely with claims … 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. (Syracuse, NY)
- …for developing, improving and continuing the process billing of medical claims for specialty pharmacy facilities. Needs to communicate financial and clinical ... for services. **Travel** : Limited travel may be required. Travel to healthcare providers and to various business and management conferences required. Travel to… more
- Molina Healthcare (Yonkers, NY)
- …including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems ... Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. **Required Qualifications** *… more