- Rochester Regional Health (Rochester, NY)
- …effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials ... a complex business process. STATUS: LOCATION: DEPARTMENT: SCHEDULE: Key Responsibilities: + Review and accurately process claim edits in a system work queue.… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …with, and/or be a critical partner to Early Phase & Translational Medical , Clinical Development, Value and Real-World Evidence, Regulatory, Medical Affairs, ... on study concepts and study protocols in governance meeting and review processes + Prepare reports and presentations summarizing findings, recommendations and… more
- Adecco US, Inc. (New York, NY)
- …team. You will work on new product concepts-from initial positioning to claims validation-ensuring that all benefits are backed by scientific evidence prior to ... new product concepts (eg, anti-aging, suncare, brightening). + Assess product claims against existing scientific evidence; design and oversee clinical studies to… more
- Rochester Regional Health (Rochester, NY)
- …effectively and accurately managing a receivable . Resolve edits to ensure accurate claims are sent to primary and secondary insurances . Research and resolve ... ways to improve a complex business process. RESPONSIBILITIES: + Review and accurately process claim edits in a system...policies and/or phone calls to the payer. Submit corrected claims and appeals. + Process account adjustments and refunds… more
- Sedgwick (Albany, NY)
- …new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff. ... and high quality delivery of case management and utilization review services to clients for multiple business lines; and...education and experience required to include five (5) years medical case management, two (2) years clinical experience, two… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements + Analyze payer criteria and provide ... territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization… more
- CDPHP (Albany, NY)
- …as Marketing, Enrollment, Pharmacy (internal and external), Provider Services, and Claims Operations to resolve member inquiries as defined within Member Services ... Procedures. The incumbent will also review eligibility requirements, provide rates for various health products,...call center preferred. + A background in health insurance claims and appeals processing is preferred. + Experience with… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …and Risks will be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and strategy and gain a ... develops systems for Clinical vendor management and vendor oversight. + **Management Review :** Establish and maintain a system to ensure R&D Management Reviews are… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …may be assigned at any time with or without notice. Primary Responsibilities + Thorough review of claims and medical documentation. + Prepare cases for ... expedition of customer requests. + Research and document pertinent information on claims requiring adjudication. + Assist Customer Service in responding to and… more
- Elevance Health (Latham, NY)
- …law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more