• Payment Integrity DRG Coding & Clinical Validation…

    Excellus BlueCross BlueShield (Rochester, NY)
    …. Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform. . Manages case volumes and review/audit schedules, ... 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines,.... Intermediate knowledge of PC, software, auditing tools and claims processing systems. Level II (in addition… more
    Excellus BlueCross BlueShield (10/23/25)
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  • Associate Director, Medical Omnichannel…

    Otsuka America Pharmaceutical Inc. (Albany, NY)
    …to create a unified view of stakeholder interactions. + Apply natural language processing (NLP) to extract insights from unstructured medical texts, such as ... that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the...Management** + Explore and analyze common pharmaceuticals data (eg, claims ) as well as novel data sets based on… more
    Otsuka America Pharmaceutical Inc. (12/03/25)
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  • Accounting: Accounts Receivable, Medical

    FLACRA (Newark, NY)
    …FLACRA's billing and payment collection processes. This position is responsible for processing claims , managing accounts receivable, and ensuring timely and ... Accounting: Accounts Receivable, Medical Biller FLACRA Newark, NY (Onsite) Full-Time $20.00...balances. + Work with insurance companies to address disputed claims and resolve processing issues. + Maintain… more
    FLACRA (11/05/25)
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  • Senior Contracting Compliance Analyst…

    Mount Sinai Health System (New York, NY)
    …processes, and related regulations. ? Familiarity with contract terms, NYS regulations, claims processing , and healthcare reimbursement models. ? Experience in ... to ensure proper interpretation and application of terms during claims processing . * Ensure that all contract...Sinai Health System is one of the largest academic medical systems in the New York metro area, with… more
    Mount Sinai Health System (10/08/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Albany, NY)
    …concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems ... or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation… more
    Molina Healthcare (12/06/25)
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  • Senior Billing Specialist

    Access: Supports For Living (Middletown, NY)
    …identified revenue cycle billing issues + Handling billing cycle review procedures for pre- processing (scrubbing) of weekly claims processing + Analyze, ... billing and processing program claims for accuracy and completeness; submit claims ...well as on a collaborative team. + Knowledge of Medical Insurance programs such as Medicaid, Medicare and Dual… more
    Access: Supports For Living (12/04/25)
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  • Medical Secretary

    UHS (Binghamton, NY)
    …Administrative Secretary on a monthly basis + Tracks and assists with documentation and claims processing for Medicare and Workers' Compensation claims to ... ensure reimbursement of rehab services. + Assists HIM in processing medical record requests and ensures authorization to release patient information + Collects… more
    UHS (12/12/25)
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  • Unemployment Specialist

    Sedgwick (Albany, NY)
    …containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Communicates claim action/ processing with ... claimant, client, state agency, managed care organization and appropriate medical contact. + Ensures claims files are properly documented and claims coding… more
    Sedgwick (12/11/25)
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  • Manager, Medical Economics (New York Health…

    Molina Healthcare (Buffalo, NY)
    …of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
    Molina Healthcare (11/21/25)
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  • Senior Director, Medical Communications,…

    Otsuka America Pharmaceutical Inc. (Albany, NY)
    **Job Summary** The Senior Director, Medical Communications, Nephrology & Immunology directs and provides strategic leadership for the global scientific ... directing the development and dissemination of all core scientific and medical content (eg, global slide decks, congress abstracts/presentations, publications, … more
    Otsuka America Pharmaceutical Inc. (11/14/25)
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