- Evolent (Albany, NY)
- …- Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in ... assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable experience with Testing, Writing Test cases, Test Plans,… more
- Evolent (Albany, NY)
- …accounts + Strong knowledge of health plan operations, care/utilization management, claims processing, value-based care, and the levers to optimize financial ... be leveraged to identify opportunities and actions (including EMR, clinical, authorization, claims , SDoH, etc.); understanding of how to translate data and insights… more
- Evolent (Albany, NY)
- …You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population ... with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including prior authorization data… more
- City of New York (New York, NY)
- …payments in compliance with financial policies and procedures. - Examine invoices, claims , fee collection or applications for recoupments, refunds and verify their ... revenue collection for outstanding balances. Investigate and research unidentified claims /payments received to determine its appropriateness to deposit the payments.… more
- Catholic Health Services (Melville, NY)
- …Catholic Health was named Long Island's Top Workplace! Position Summary: Manage underpaid insurance balances that are unable to be resolved through routine follow up ... himself/herself in conformity with the CHS Security policies and procedures. Analyze claims data with the goal of identifying and quantifying payment issues and… more
- Mount Sinai Health System (New York, NY)
- …knowledge of a health care EMR such as Epic/Clarity, eCW, etc.; a payor claims system such as Facets, Amisys, etc.; or a hospital/provider system such as IDX, ... Competencies** + Demonstrates the ability to assure compliance with regulatory, insurance and ethical standards regarding safety of patients, employees and property.… more
- Molina Healthcare (Albany, NY)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... with the Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina and presents cases… more
- Robert Half Legal (New York, NY)
- …actions, as well as individual and class-wide discrimination, harassment, and retaliation claims under federal, state, and local laws. This is a hands-on role ... with a focus on employment law + Demonstrated experience with wage-and-hour claims + Substantial deposition experience + Strong legal research and writing skills… more
- City of New York (New York, NY)
- …telephone contacts and other means for referral to the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP CR). - Review claims calculations and ... eligibility for public assistance or unemployment, health benefits, social security, insurance , or participation in social services or community programs, and other… more
- CDPHP (Latham, NY)
- …and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, ... and external customers at all levels of authority + Understanding of claims and claims payments CDPHP salary ranges are designed to be competitive with room… more