- New York eHealth Collaborative (New York, NY)
- …to manage large and complex datasets (eg, master patient indexes, SPARCS, healthcare claims ). + Design, implement, maintain, and enhance data workflows, ... experience in data analytics or health informatics within the healthcare industry or a medical environment; strong...+ Familiarity with Clinical Quality reporting, Medicare and Medicaid claims data, ICD coding , CDA standards, web… more
- Highmark Health (Buffalo, NY)
- …This includes analysis and interpretation of claims submission for superior coding accuracy, cost and utilization reports, medical loss ratio reports, ... relevant, dissemination and support of gap closures for STARS and improved coding for government populations. Identification of process improvement gaps in workflow… more
- Cognizant (Albany, NY)
- …**Qualifications/Skills Needed:** 1-2 years of Appeals and Grievance 1 yr. medical claims processing experience (Must be with a healthcare plan, not on ... Service with managed care plans or directly with CMS Billing and Coding - Medical Insurance Knowledge of Member/Provider Appeals and Grievances, processes,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely...and Federal Mandates. + May be responsible for pricing, coding , researching claims to ensure accurate application… more
- Mohawk Valley Health System (Utica, NY)
- …appointment coordination, and patient registration processes. + Ensure compliance with healthcare regulations and maintain accurate medical records. Staff ... manner, also in partnership with HR. Financial Management: + Oversee billing and coding processes, including insurance claims and patient billing. + Ensure… more
- Capgemini (New York, NY)
- …administration claims billing and CRM systems Establish reusable components coding standards and deployment models for enterprise grade platforms Implement cloud ... design and development efforts for digital servicing policy management and claims platforms **Key Responsibilities:** Define architecture for responsive secure and… more
- Cognizant (Albany, NY)
- …to be considered: *High school diploma or GED *Proven experience working in healthcare revenue cycle with specializing in hospital claims . *Expertise in ... you will perform advanced level work related to resolution of hospital claims . You will be responsible for resolving aged hospital accounts receivables, identifying… more
- Cardinal Health (Albany, NY)
- …team to ensure timely and accurate resolution of outstanding insurance claims . This role leads strategy development, performance monitoring, and process improvement ... evaluations for AR follow-up staff. + Coordinate with billing, coding , and other departments to address claim issues and...as the point of escalation for complex or high-dollar claims . + Stay current with payer policy changes, compliance… more
- MVP Health Care (Rochester, NY)
- …justice or a related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation experience with law ... to the above requirements: A duly licensed or authorized medical professional, including but not limited to MD or...CPC and/or COC credential. + Maintain nursing license and coding credentials through continuing education process as required. +… more
- Independent Health (Buffalo, NY)
- …Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in support ... and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This position will prepare written responses to appeals and… more
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