- MVP Health Care (Rochester, NY)
- …**Your key responsibilities:** + Mentor, support, and build a high-performing team within Claims Operations. + Supervise claims processing activities related ... improvement. To achieve this, we're looking for a Leader, Claims Support to join #TeamMVP. If you have a...that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Healthfirst (NY)
- …contract reimbursement terms, code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants ... and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital… more
- Humana (Albany, NY)
- …of operations, technology, communications, and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- Molina Healthcare (Syracuse, NY)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more
- Molina Healthcare (NY)
- …communicate written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims ... order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific… more
- Molina Healthcare (Buffalo, NY)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
- Molina Healthcare (Syracuse, NY)
- …Provides leadership and direction to MMS Operational Units management staff (eg, Claims Processing , Provider Services, Provider Enrollment, Finance, Managed Care ... or equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high… more
- Molina Healthcare (Buffalo, NY)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
- Molina Healthcare (Yonkers, NY)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more