- Molina Healthcare (Albany, NY)
- … function efficiency. **Required Qualifications** * At least 3 years of medical claims processing experience, or equivalent combination of relevant education ... and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to… 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, Medicare Advantage, and Medicaid requirements… 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
- AON (NY)
- …provisions. + Examine claim submissions and documentation to confirm coverage and assess claims . + Review medical records, itineraries and other documentation to ... provisions. + Examine claim submissions and documentation to confirm coverage and assess claims . + Review medical records, itineraries and other documentation to… more
- Highmark Health (Albany, NY)
- …including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims , and Medical Policy. The person in this position must ... resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a...of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing… more
- Molina Healthcare (Buffalo, NY)
- …care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases ... ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by applying advanced… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical ... needed. Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims...Come In** The Medical Coding Auditor reviews medical claims submitted against medical … more
- Robert Half Accountemps (Rochester, NY)
- …detail to maintain smooth financial operations. Responsibilities: * Process and submit medical claims accurately through various billing software systems. * ... unpaid claims and outstanding balances. Requirements * Proven experience in medical billing, including claims administration and appeals. * Proficiency in… more
- Sedgwick (Albany, NY)
- …**ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and ... Disability Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical ... with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria,… more