- CVS Health (Amherst, NY)
- …by the stop loss carrier. **Required Qualifications** *Minimum of 1 year of experience in healthcare claims processing *Minimum of 2 years of experience with ... This challenging role provides exposure to virtually all aspects of healthcare claims administration, from reinsurance/stop loss, data analytics, provider… more
- Humana (Albany, NY)
- …MBA, JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process ... Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- MVP Health Care (Schenectady, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a Medical Claims Examiner to join #TeamMVP. This is the opportunity for you if you ... responsibilities:** + Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess...that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.… more
- Molina Healthcare (Rochester, NY)
- …Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing /resolution, including ... Contracted Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility… more
- Cognizant (Albany, NY)
- …duties as assigned by management. **Qualifications:** + A minimum of 1 year's claims processing experience is required. + Knowledge of physician practice and ... able to work with minimal supervision. + Excellent problem-solving skill in healthcare claims adjudication. + Ability to work at a computer for extended periods.… more
- Cognizant (Albany, NY)
- …Monday to Friday 8am - 4:30pm ET **Experience:** A minimum of 1 years claims processing is required. **Travel:** None required **About the role:** As ... to be considered:** * A minimum of 1 year claims processing is required. * Knowledge of...with good skills a problem resolution specifically related to healthcare claim adjudication. * Possess ability to work at… more
- Cognizant (Albany, NY)
- …School Diploma or equivalent is required + A minimum of 1 years of medical claims processing is required + Facets experience is highly preferred + Knowledge of ... payment and coverage guidelines and regulations + Experience in the analysis and processing of claims , utilization review/quality assurance procedures + Must be… more
- Mount Sinai Health System (New York, NY)
- … processes, and related regulations. * Familiarity with contract terms, NYS regulations, claims processing , and healthcare reimbursement models. * Experience ... Minimum of 7 years of experience in contract compliance, healthcare compliance, or revenue cycle management, with a strong...to ensure proper interpretation and application of terms during claims processing . * Ensure that all contract… more
- Healthfirst (NY)
- …with HRP implementation and claims processing + Prior experience with claims and provider payment operations in a healthcare payor setting + Experience ... + Assists in the development of strategic plans to ensure modern and efficient claims processing across the entire lifecycle with a focus on a unified,… more
- CVS Health (New York, NY)
- … processes analysis. Facilitate effective solutions related to adjudication and processing of pharmacy and vaccine/medical claims , maintaining current services, ... * Development of billing/vendor solutions that enable business growth/new healthcare services, working cross-functionally to prioritize, structure timelines, develop… more