- Molina Healthcare (Albany, NY)
- …equivalent combination of education and experience **PREFERRED EXPERIENCE:** 3+ years Healthcare Claims Adjudication **PHYSICAL DEMANDS:** Working environment is ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- Sanofi Group (New York, NY)
- …detail-oriented problem solver with deep operational knowledge of the US healthcare system, including formulary operations , claims adjudication, ... **Job Title:** Associate Director, National Account Operations CVS - US Remote **Location:** Remote/Field Based...and contract performance tracking. We are an innovative global healthcare company, committed to transforming the lives of people… more
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Analyzes complex claims business problems and issues using data from internal and external sources to provide insight to ... with multiple types of business data. May be internal operations -focused or external client-focused. **KNOWLEDGE/SKILLS/ABILITIES** + Elicit requirements using… more
- Cognizant (Albany, NY)
- …variety of business operations . We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims Processor** is ... responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to … more
- Northwell Health (New York, NY)
- …basis. (Coding/ Claims experience needed, Data Analysis a plus) The Claims Specialist will support department operations related to provider communication, ... Eight or more years of insurance experience within a healthcare or managed care setting (preferred) + Claims... healthcare or managed care setting (preferred) + Claims adjudication experience + Knowledge of MLTC/ Medicaid/Medicaid benefit… more
- FlexStaff (Bronx, NY)
- **Req Number** 154447 FlexStaff is seeking a Claims Specialist to support department operations related to provider communication, pending claim review, ... Friday in the office. Responsibilities: + Reviews and investigates claims to be adjudicated by the TPA, including the...Eight or more years of insurance experience within a healthcare or managed care setting (preferred) + Prior third… more
- Healthfirst (NY)
- …problem solving, and analytical skills. + Experience within any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). ... value. + Collaborate with Information Technology, Business Transformation and Operations teams to support effective department management including introducing new… more
- Molina Healthcare (Albany, NY)
- …trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... **Job Description** **Job Summary** The Health Plan Operations , Payment Integrity Program Manager is an individual...operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to… more
- Molina Healthcare (Buffalo, NY)
- …solutions. * Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. * ... and collaborate cross-functionally to drive data-informed decisions in clinical and business operations . * Maintain fluency in healthcare data types (eg, ICD/CPT… more
- Molina Healthcare (Buffalo, NY)
- …technical solutions. + Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and ... and collaborate cross-functionally to drive data-informed decisions in clinical and business operations . + Maintain fluency in healthcare data types (eg, ICD/CPT… more