- Molina Healthcare (Buffalo, NY)
- …Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS ... + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (Buffalo, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical ... software program(s) proficiency. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive… more
- Molina Healthcare (Yonkers, NY)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission… more
- Molina Healthcare (Buffalo, NY)
- …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Syracuse, NY)
- …member inquiries, questions and concerns in all areas including enrollment, claims , benefit interpretation, and referrals/authorizations for medical care. + Provides ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Albany, NY)
- …services, pharmacies, and health plan providers in resolving member prescription claims , prior authorizations, and pharmacy service access issues. * Articulates ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Syracuse, NY)
- …member eligibility and covered benefits, Provider Portal, and status of submitted claims . * Ability to effectively communicate in a professionally setting. **Job ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Yonkers, NY)
- …care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Rochester, NY)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- KPH Healthcare Services, Inc. (Watertown, NY)
- …for collecting, posting and managing account payments. + Prepares and submits claims to various insurance companies and follow up when appropriate. + Prepare, ... multiple factors such as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides by all local,… more
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