- Catholic Health (Buffalo, NY)
- …from Overtime: Exempt: Yes Work Schedule: Days Hours: 8-4 Summary: The Healthcare Analyst III will be responsible for compiling, formatting, maintaining and ... analyzing health care electronic medical record and claims data in order to track and trend health care utilization and quality of care for the population health… more
- Molina Healthcare (Rochester, NY)
- …Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's… more
- Molina Healthcare (Albany, NY)
- …vendor, and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Review of claims identified ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (NY)
- …release notes to accurately request and analyze impact reports of affected claims . + Analyzes, interprets, and maintains configurable tables and files that support ... or reimbursement processes + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg, performing… more
- Molina Healthcare (Yonkers, NY)
- …and business leaders to enable enterprise wide capabilities. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... the Provider Online Directory, Utilization Management, Customer Experience, Enrollment, and Claims Payment and Processing. + Develop and enforce operating procedures… more
- Molina Healthcare (Yonkers, NY)
- **JOB DESCRIPTION** **Job Summary** The Molina Healthcare Internship Program shares an objective to create a stepping stone for students who aim to be professionals ... and future leaders in the healthcare business profession. Interns are assigned special projects and...learning and rule-based logic to detect potentially incorrectly paid claims . + Contribute to improve data quality, perform data… more
- Molina Healthcare (Rochester, NY)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to organize,… more
- Molina Healthcare (Albany, NY)
- …medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- KPH Healthcare Services, Inc. (Rochester, NY)
- …and follow-up + Track and re-bill pending Medicaid accounts + Re-bill claims as needed + Identify pattern problems (improper patient demographic data entered, ... and private pay + Month-end closing process + Re-bill claims to improve reimbursement from NETRX reporting + Assist...as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides… more
- Molina Healthcare (NY)
- …DESCRIPTION** **Job Summary** Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and ... credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. *… more
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