- CVS Health (Albany, NY)
- …with complaints and/or Center for Medicare and Medicaid Services (CMS) + Medical /RX claim processing knowledge + Bachelors Degree **Education:** High School ... queue of Medicare complaints. These complaints can include various issues ranging from claims that are adjudicated incorrectly to rude customer service. You will be… more
- OLV Human Services (Lackawanna, NY)
- …individuals. - Leads the Site Team in weekly discussion to ensure that all medical appointments are completed as scheduled and that all necessary follow up is ... (Including but not limited to: Life Plans, LCED's, meal intake, medical monitoring, medication administration, staff action program data/goals, Therap notes,… more
- Highmark Health (Albany, NY)
- …(AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must ... to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + Responsible for… more
- CVS Health (New York, NY)
- …NextGen Production Support Environment team, focusing on Non-Production Support: + Claims system: Health Rules Payer (HRP) + Enrollment systems: Market Prominence ... multi-tier applications. + 3+ years experience with or exposure to batch processing , monitoring technologies, and trend analysis + Knowledge or experience with… more
- CVS Health (New York, NY)
- …mathematical analysis methods, including predictive analytics, natural language processing , reinforcement learning and causal inference with in-depth specialization ... in some areas + Experience working with healthcare data, including claims data, provider data, and / or clinical data + Experience mentoring junior data scientists… more
- CDPHP (Albany, NY)
- …two (2) years Utilization Management experience is preferred. + Knowledge of coding/ claims processing is preferred. + Experience working with Microsoft Office, ... authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is… more
- Independent Health (Buffalo, NY)
- …Pharmacy Technician Certification (CPhT) preferred. + Experience working with on line claims processing system preferred. + Effective oral and written ... and insurance companies, and facilitate communication between patients and doctors, medical staff and administrative staff. + Maintain patient records; filing,… more
- Jacobs (Garden City, NY)
- …report on, public outreach documents, DBE compliance, and invoice review and processing for payment for client contracts. * Perform record-keeping tasks including ... facing materials, public interactions, and responses * Monitor damage and public claims and ensure satisfactory resolution. * On a monthly basis review, comment… more
- UHS (Johnson City, NY)
- …teams by assisting in the reconsideration and appeals process for denied claims + Collaborates with clinical and administrative teams to ensure documentation meets ... billing and clerical work + Previous experience in data processing + Certified home care and/or utilization review work...Comprehensive Benefits for Life & Family - We offer medical , dental, and vision coverage starting the first of… more
- Guardian Life (Albany, NY)
- …AI. + Apply AI/ML to unstructured data sources such as insurance contracts, medical records, sales notes, and customer service logs. + Deliver solutions that enhance ... underwriting risk assessment, claims auto-adjudication, and customer servicing. Operational Excellence + Establish scalable processes, frameworks, and governance… more