- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION Job Summary Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating ... information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness… more
- Molina Healthcare (Buffalo, NY)
- …likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge ... specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program… more
- CVS Health (Albany, NY)
- …3-5 years. + Strong analytical and investigative skills, with experience in healthcare fraud detection. + Proficiency in interpreting claims data, medical ... that may compromise the integrity of the organization's operations and claims processes. **Core Responsibilities** + **Investigative Leadership** : Conducts thorough… more
- Molina Healthcare (Albany, NY)
- …network adequacy and provider training and education, in alignment with Molina Healthcare 's overall mission, core values, and strategic plan and in compliance with ... staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for...3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5… more
- Molina Healthcare (Bronx, NY)
- …network adequacy and provider training and education, in alignment with Molina Healthcare 's overall mission, core values, and strategic plan and in compliance with ... staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for...3 - 5 years customer service, provider service, or claims experience in a managed care setting. * 3+… more
- Kyndryl (Albany, NY)
- …transforming Contact Center operations for enterprise organizations, particularly those in the Healthcare or State or Local Government and / or Educational (SLED) ... communication, presentation, and stakeholder management skills with C-Level. + Healthcare industry experience is a strong plus, especially in payer/provider… more
- Molina Healthcare (Rochester, NY)
- …Supporting the OH Plan, the candidate will act as the Ohio Operation lead on Claims and Encounters as well as the liaison to our state regulator in these areas. ... developer role but the candidate must be technically inclined and interface with IT, Claims , and Encounter Teams. Must be a self-starter willing to learn. Must be a… more
- Oracle (Albany, NY)
- …data in at least one visualization tool like BO or Tableau + Healthcare experience with Medicaid/Medicare Claims Reporting **Expectations** + Perform other ... and save lives. Our mission? To create a human-centric healthcare experience powered by unified global data. It's a...care across the globe. If you're excited about making healthcare more human, you've come to the right place.… more
- Mount Sinai Health System (New York, NY)
- …focus on accuracy and compliance. **Preferred Skills:** + In-depth knowledge of healthcare revenue cycle processes, including billing, claims management, and ... Opportunity to work at the forefront of innovation in healthcare The Managed Care Contracting Team within MSHP is...Revenue Cycle team to integrate contract terms into billing, claims , and payment systems. + Provide support and guidance… more
- Cognizant (Albany, NY)
- **Facets Healthcare Developer** **Work Model: Remote** **Employment Type: Full-Time** **Job ID: 00065752001** **About the role** As a **Senior Developer** , you will ... make an impact by designing, developing, and deploying robust solutions for healthcare platforms. You will be a valued member of the delivery team and work… more
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