- Molina Healthcare (Yonkers, NY)
- …+ Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing , and knowledge of regulatory… more
- Molina Healthcare (Yonkers, NY)
- …experience **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing /resolution, including 3 ... Medicare standards and requirements related to member and provider dispute/appeals processing . *Requires state level knowledge and experience of Integrated Dual… more
- Molina Healthcare (Yonkers, NY)
- …operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms (eg, PMPM, ... related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more
- Molina Healthcare (Syracuse, NY)
- …Ensure that provider information is loaded accurately to allow for proper claims processing , outbound reporting and directory processes. **JOB QUALIFICATIONS** ... for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims… more
- Molina Healthcare (Yonkers, NY)
- …optimize data models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional ... in Big Data engineering or analytics. * Prior experience working in the healthcare industry with familiarity in clinical, claims , or care management data.… more
- Molina Healthcare (Yonkers, NY)
- …in Medicaid, Medicare, and Marketplace lines of business. + Familiarity with QNXT claims processing platform. + Knowledge of legal procedures related to complex ... The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace lines of business.… more
- Molina Healthcare (NY)
- …applicants. * Completes data corrections in the credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems ... Description** **Job Summary** Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and… more
- Molina Healthcare (Buffalo, NY)
- …applicants. * Completes data corrections in the credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems ... DESCRIPTION** **Job Summary** Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and… more
- KPH Healthcare Services, Inc. (Seneca Falls, NY)
- …personally or through subordinates. Assist the professional staff in the triaging, processing and delivery of prescriptions to the patient. Assist in the management ... submission, and resubmission (as required) of all third party claims + Assist in the management of the pharmacy...in the management of the pharmacy inventory, including transmitting, processing and receiving orders to the Kinney Warehouse and… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …refund requests + Complex account reconciliation + Account adjustments, bad debt processing + Third party, Medicare, Managed Care, and private billing, claim ... + Track and re-bill pending Medicaid accounts + Re-bill claims as needed + Identify pattern problems (improper patient...as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides… more