- Molina Healthcare (NY)
- … Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …data. Essential Accountabilities: Level I . Analyzes and audits acute inpatient claims . Integrates medical chart coding principles, clinical guidelines, ... of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology. . Coding Certification… more
- Ideal Home Care (Islandia, NY)
- …with healthcare regulations. Key Responsibilities: + Curriculum Delivery: Teach medical billing and coding courses, including healthcare terminology, ... ICD-10, CPT, HCPCS coding systems, insurance claims , reimbursement processes, and regulatory compliance. + Instructional Methods:...+ Minimum of 2 years of professional experience in medical billing, coding , or healthcare … more
- Ellis Medicine (Schenectady, NY)
- The Supervisor, Medical Coding - Outpatient is responsible for the oversight and development of the office coding department. This includes mentorship and ... direct management of the outpatient medical coding team. The Supervisor of ...coding and billing experience required. Working knowledge of healthcare revenue cycle functions, including coding and… more
- University of Rochester (Rochester, NY)
- …+ Demonstrated working knowledge of the professional billing software applications + Active medical coding credential with AHIMA as RHIT, RHIA, CCS, CCS-P, AAPC ... charging and receivables. These activities include, but are not limited to, coding abstraction, pre-bill coding edits, claims resolution functions,… more
- Intermountain Health (Albany, NY)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... codes in support of the provision of value-based care by Intermountain Healthcare to appropriate populations. It ensures compliance and accurate submission of… more
- CDPHP (Latham, NY)
- …and adjustments. In addition, the incumbent will utilize and interpret Claims Operations Policies and Procedures, coding methodologies, Plan contract ... these values and invites you to be a part of that experience. The Claims Representative shall assume full responsibility and ownership for all aspects regarding … more
- MVP Health Care (Schenectady, NY)
- …looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you. **What's in ... care experience required + Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. +...responsibilities:** + Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, and Medicare Advantage requirements… more
- MetLife (Oriskany, NY)
- …made by team member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and ... Preferred: . Associate Degree . 2 plus years of claims management experience preferably in Healthcare field...Skills, Preferred: * Prior STD, state leave and/or Family Medical Leave Act claims knowledge preferred. *… more
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