- Molina Healthcare (Buffalo, NY)
- …**X** **PE** **R** **I** **E** **N** **C** **E:** + Min. 3 years operational managed care experience (call center, appeals or claims environment). + Health ... claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. + Strong… more
- Northwell Health (New York, NY)
- …Experience: + Eight or more years of insurance experience within a healthcare or managed care setting (preferred) + Claims adjudication experience + Knowledge of ... MLTC/ Medicaid/Medicaid benefit + Knowledge of Member (Subscriber) enrollment & billing + Knowledge of Utilization Authorizations + Knowledge of Provider Contracting + Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS + Proficiency in MS Excel, Word,… more
- FlexStaff (Bronx, NY)
- …plus) + Eight or more years of insurance experience within a healthcare or managed care setting (preferred) + Prior third party insurance billing experience, ... required. + Knowledge of medical terminology, preferred. + Ability to communicate effectively. *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful… more
- Molina Healthcare (Rochester, NY)
- …and experience **Required Experience** + 3-5 Years of business analysis + 4+ years managed care experience + Demonstrates familiarity in a variety of concepts, ... practices, and procedures applicable to job-related subject areas. **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** + 1-3 years formal training in Business Analysis and/or Systems Analysis… more
- SUNY Upstate Medical University (Syracuse, NY)
- …oral, and electronic forms required. Preferred Qualifications: Knowledge of managed care enrollment desirable. Credentialing experience preferred. Certification ... as either Provider Credentialing Specialist (CPCS) or Professional in Medical Services Management (CPMSM) from the National Association of Medical Staff Services preferred. Work Days: M-F 7:30-4:00 Message to Applicants: Recruitment Office: Human Resources more
- Molina Healthcare (Syracuse, NY)
- …or equivalent combination of relevant education and experience + Medicare and/or Medicaid Managed Care experience + Quantitative aptitude + Strong leadership in ... a matrixed environment + Strong project management skills and ability to manage multiple, competing priorities and projects simultaneously. + Excellent communication and people skills, including ability to effectively collaborator with business unit leaders,… more
- Molina Healthcare (Albany, NY)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 10 years' experience in Managed Care , specifically government programs and/or Medicare/Duals Health Plan ... Operations or equivalent combination of education and experience. + Strong leadership in a matrixed environment + Demonstrated adaptability and flexibility to a rapidly moving business environment. + Background analyzing technical performance and driving teams… more
- Molina Healthcare (NY)
- …experience and at least 2 years experience in the overread role. + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA. **PR** **E** **FE** ... **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C**… more
- Actalent (Buffalo, NY)
- …Additional Skills & Qualifications + PharmD or Bachelor of Science accepted. + Managed care experience preferred. + Experience in retail pharmacy is ... advantageous. + Quick learner with the ability to adapt to new systems. + Comfortable with contract work. Work Environment This role offers a 100% remote work environment with hours from 8:30 am to 5:00 pm, Monday through Friday. Must be local to Buffalo New… more
- Stony Brook University (East Setauket, NY)
- …York Medicaid reimbursement methodologies. + Knowledge of third party payer reimbursement and managed care contracts. + Knowledge of CPT, HCPCs and ICD-10 coding ... principles. + Experience with Cerner Invision and/or Cerner Millennium Patient Accounting. + Experience in Insurance Verification. + Experience working in Medicare FSS DDE system. **Special Notes** **:** **Resume/CV should be included with the online… more