- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and ... organized and analytical thinking. Experience with Medicare/Medicaid, MS 365 and familiarity with claims is highly preferred. The Case Manager must be able to work… more
- Molina Healthcare (Buffalo, NY)
- …and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. + Requests and obtains medical records, notes, and/or detailed bills ... **I** **E** **N** **C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed… more
- Molina Healthcare (Syracuse, NY)
- …experience working in Medicare + Must have experience analyzing claims . **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree and/or equivalent ... care industry in related field **PREFERRED EDUCATION:** Bachelor's degree in healthcare related field **PREFERRED EXPERIENCE:** 4-6 years experience in healthcare… more
- Molina Healthcare (Syracuse, NY)
- …Experience** 7-9 years Application Design, Development Experience and, Management, Healthcare Industry **Preferred Experience** 10+ years, Healthcare Industry ... with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS… more
- Molina Healthcare (Rochester, NY)
- …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 5 - 7 years in healthcare /managed care industry with knowledge of provider contracting, provider reimbursement, ... or Economics **PREFERRED EXPERIENCE:** Experience working with medical and pharmacy claims , authorization data, benefits design, medical management as well as… more
- Molina Healthcare (Syracuse, 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. Ongoing… more
- Molina Healthcare (Albany, 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
- Molina Healthcare (Rochester, NY)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... **Preferred Education** Associate degree **Preferred Experience** + 3-5 years; healthcare industry experience preferred + National pharmacy technician certification… more
- KPH Healthcare Services, Inc. (Camden, 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
- Molina Healthcare (Rochester, 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