• Medicaid Integrity Specialist 1/Trainee 1/Trainee…

    New York State Civil Service (Albany, NY)
    …care organizations which includes evaluations of financial records and medical claims .* Propose solutions to the audit team regarding issues encountered ... positions include auditors, investigators, nurses, data analysts, pharmacists, other clinical/ medical professionals, compliance specialists, program administrators/managers, and persons providing… more
    New York State Civil Service (06/06/25)
    - Related Jobs

  • Insurance Internal Auditor

    ManpowerGroup (New York, NY)
    …processes, identify discrepancies, and collaborate with various departments to ensure proper claims handling. **Key Responsibilities:** + Audit Life Insurance ... in providing training and guidance to junior auditors and other staff on audit processes, policies, and compliance requirements. + Claims Process Improvement:… more
    ManpowerGroup (04/12/25)
    - Related Jobs

  • 340B Analyst

    Albany Medical Center (Albany, NY)
    …based on the requirements of the 340B program. This person will extensively audit prescription claims and report findings while making recommendations for ... for advising, establishing, and helping to implement the outpatient prescription qualification/ audit process in conjunction with the 340B Compliance Specialist. This… more
    Albany Medical Center (03/26/25)
    - Related Jobs

  • Remote Accommodations Clinical Specialist-…

    Sedgwick (Albany, NY)
    …work restrictions/accommodations. + Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate ... the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
    Sedgwick (05/23/25)
    - Related Jobs

  • Inpatient Clinical & Coding Specialist - Senior

    Independent Health (Buffalo, NY)
    …statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding ... will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing,… more
    Independent Health (04/15/25)
    - Related Jobs

  • HCC Coding Quality Analyst

    Independent Health (Buffalo, NY)
    …of coding and documentation. The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification of the ... audit results when indicated. + Responsible for in-house medical record reviews from faxed in, mailed in, or...have been assigned per practice manager. + in the claims review, medical record capture and review,… more
    Independent Health (06/03/25)
    - Related Jobs

  • Investigations Coordinator

    Highmark Health (Albany, NY)
    …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
    Highmark Health (06/03/25)
    - Related Jobs

  • Workforce Absence Team Lead

    Sedgwick (Albany, NY)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
    Sedgwick (05/20/25)
    - Related Jobs

  • Claim Preparation - Business Intruption - Forensic…

    AON (New York, NY)
    …What the day will look like As respects property damage and business interruption claims + Review, audit and analyze accounting books and records, financial ... What the day will look like As respects property damage and business interruption claims + Review, audit and analyze accounting books and records, financial… more
    AON (05/13/25)
    - Related Jobs

  • Collections and Eligibility Specialist - Clinic

    YAI (Manhattan, NY)
    …electronic systems to review new and pending transactions and prepares/submits completed medical claims electronically (and when applicable by paper) to ... through commercial insurance, Medicare and/or Medicaid and assessing eligibility for medical /clinical services received at Article 16 and Article 28 clinics. Ensures… more
    YAI (05/23/25)
    - Related Jobs