- Highmark Health (Buffalo, NY)
- …gain/risk share contract parameters. This includes analysis and interpretation of claims submission for superior coding accuracy, cost and utilization reports, ... medical loss ratio reports, Medicare STARS gaps and other...metrics, accountable care organization development and support, patient centered medical home, and electronic health records. + Experience may… more
- WTW (New York, NY)
- …phone and face to face with clients. + Champion the proper advocacy of claims . + Participate in stewardship meetings. + Support Client Management team in identifying ... following (eligibility requirements apply): + **Health and Welfare Benefits:** Medical (including prescription coverage), Dental, Vision, Health Savings Account,… more
- WSP USA (New York, NY)
- …Certificates and ensure timeous invoicing. + Actively participate in mitigating potential claims and variation orders and where they do arise, prepare detailed ... and Benefits:** WSP provides a comprehensive suite of benefits including medical , dental, vision, disability, life, and retirement savings focused on a… more
- Intermountain Health (Albany, NY)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... coding in an inpatient hospital setting. AND Demonstrated understanding of medical terminology, medical acronyms, anatomy and physiology. AND Demonstrated… more
- Elevance Health (Latham, NY)
- …of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment ... of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management… more
- CVS Health (New York, NY)
- …in-depth specialization in some areas + Experience working with healthcare data, including claims data, provider data, and / or clinical data + Experience mentoring ... to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and… more
- Catholic Health Services (Roslyn, NY)
- …corrective actions plans Responsible for professional liability discovery Attends claims litigation meeting Coordinates, investigates, trends and disseminates safety ... Improvement and Privacy programs including risk assessments and rounding Conduct medical record reviews to identify potential regulatory concerns, quality issues,… more
- CDPHP (Albany, NY)
- …authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is ... (2) years Utilization Management experience is preferred. + Knowledge of coding/ claims processing is preferred. + Experience working with Microsoft Office, including… more
- City of New York (New York, NY)
- …to prevent potential errors by reviewing records of Cash Assistance and Medical Insurance and Community Services Administration (MICSA) cases and analyzing their ... in its Eligibility Verification Division, who will: - Work on various Medical Assistance Program (MAP) projects including reviewing and analyzing MAP duplicate… more
- Sumitomo Pharma (New York, NY)
- …teams-including clinical development, clinical operations, data management, programming, and medical writing-to maintain the statistical integrity of study conduct. ... submissions by preparing responses to agency inquiries and contributing to labeling claims . + Review Case Report Forms (CRFs) to ensure data collection aligns… more