- MVP Health Care (Schenectady, NY)
- …future of healthcare payment integrity? MVP Healthcare is seeking a visionary ** Senior Director of Payment Integrity & Cost Containment** to lead enterprise-wide ... initiatives that ensure claims are paid accurately, ethically, and efficiently. This high-impact...Management & Performance Monitoring** + Manage external vendors supporting audit , analytics, and fraud detection. + Monitor vendor performance… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about ... 340+ senior focused primary care centers in 15 states. The...that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across… more
- Axis (New York, NY)
- …available upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… more
- Cardinal Health (Albany, NY)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, ... medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles… more
- New York State Civil Service (Islandia, NY)
- …State NY Zip Code 11749 Duties Description Under the direction of the Senior Workers' Compensation Claims Referee, the duties of the Workers' Compensation ... and evaluates documentary evidence and testimony, both lay and medical , given at hearing; orders medical examinations...Chair.* Performs related duties as required.* Coordinate with the Senior Workers' Compensation Claims Referee in the… more
- Amazon (New York, NY)
- …program around the world across all of its various use cases. Amazon's Last Mile Claims team is seeking a talented claims professional to support our rapidly ... You will lead strategy on complex bodily injury auto claims , handling pre-litigation disputes and resolving litigated claims...a successful candidate will support and report to a Senior Risk Manager and be enthusiastic about driving change,… more
- Molina Healthcare (NY)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... lists by helping identify and validate source data required for medical record collection. This is an ideal opportunity for an early-career analyst with a strong… more
- Independent Health (Buffalo, NY)
- …knowledge and audit tips across the team. The Clinical & Coding Specialist- Senior will support the leadership in Hospital Audit in accomplishing all aspects ... statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding… more
- Axis (New York, NY)
- …variety of loss scenarios as well as reporting and presenting about same to senior management + In-depth knowledge of claims , litigation, arbitration, and trial ... part in the selection process. **Job Description** AXIS is seeking a **_Senior Claims Specialist - Environmental Claims_** to join our North America Claims .… more
- CVS Health (Albany, NY)
- …claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency. Consults cross-functionally with other ... + Executes both routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations from standard… more