- Brighton Health Plan Solutions, LLC (New York, NY)
- …at any time with or without notice. Primary Responsibilities + Thorough review of claims and medical documentation. + Prepare cases for clinical review. + ... expedition of customer requests. + Research and document pertinent information on claims requiring adjudication. + Assist Customer Service in responding to and… more
- Alfred University (Alfred, NY)
- …of maintaining and organizing the Athletic Training Room (ATR) file system, including medical records, insurance claims and medical bills in compliance ... under the supervision of the Team Physician(s), Head Athletic Trainer, and other qualified medical personnel. This position is 20 hours per week at a rate of $35/hr.… more
- City of New York (New York, NY)
- …Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult ... it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and complicated in-patient billing.… more
- Rochester Regional Health (Rochester, NY)
- …sources such as, but not limited to, health care data systems, electronic medical records, paid claims , and national/regional benchmarks. The Quality Informatics ... color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin,… more
- Humana (Albany, NY)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …with or without notice. Primary Responsibilities + Handle inbound calls from members, medical providers, and others. + Adjust claims accurately, if needed. + ... call center, experience with claims inquiry and claims review procedures, knowledge of medical specialties,...inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call… more
- SUNY Westchester Community College (Yonkers, NY)
- …as medical coder/biller, medical biller/customer service representative, medical records clerk/assistant, and insurance claims clerk. The incumbent will ... the workforce. RESPONSIBILITIES: Seeking energetic and engaging Adjunct Faculty to teach Medical Billing and Coding classes. The incumbent will deliver a curriculum… more
- CVS Health (Albany, NY)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns ... Excel, PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior experience in… more
- Evolent (Albany, NY)
- …of 1 years of experience in technical quality assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable ... experience with Testing, Writing Test cases, Test Plans, and good understanding on what needs to be tested + Demonstrable experience in verbal and written communication with domain teams and program leadership + Demonstrable experience working concurrent… more
- University of Rochester (Brighton, NY)
- …Prepares, processes, and reviews forms for compliance, accuracy, and completion including medical documentation. Determination of how to classify claims (WC- ... medical only or loss time or if multiple claims how to address concurrent DBL and WC ...claims how to address concurrent DBL and WC claims ). Monitors, tracks, and maintains data for reporting requirements.… more