- Guardian Life (Albany, NY)
- …Communicate claim status and decisions via telephone and in writing + Prioritize and review new claims to adhere to established departmental turnaround times + ... As the ** Claims Case Manager I** , **Supplemental Insurance,** you...investigation and draft adverse determination letter if applicable + Review claim documentation to determine benefits available against policy… more
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more
- Humana (Albany, NY)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Centene Corporation (New York, NY)
- …and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for ... authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is… more
- Trinity Health (Albany, NY)
- …are submitted to insurances as "Clean Claims " + Works within the working queue to review all charges and submit to claims scrubber + Work all claims ... Full time **Shift:** Day Shift **Description:** **Revenue Cycle / Medical Billing Analyst - Oncology Team- Albany, NY -...outstanding claims to contact to ensure all claims are billed timely + Review each… more
- Molina Healthcare (Buffalo, NY)
- …of other insurance records and has a direct impact on medical expenses and premium reimbursement. **KNOWLEDGE/SKILLS/ABILITIES** + Provides telephone, clerical, and ... and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Contacts CMS directly or coordinates… more
- Robert Half Accountemps (Syracuse, NY)
- … systems, coupled with exceptional analytical and problem-solving skills. Responsibilities: * Review and verify claims for accuracy and completeness, correcting ... Description We are looking for an experienced Medical Billing Specialist to join our team in...processes for Home Health Care services, ensuring accuracy in claims submission and payment processing. Candidates should possess a… more
- Catholic Health (Buffalo, NY)
- …Skill and Ability + Demonstrates knowledge of third party billing procedures + Knowledge of claims review and process + Strong computer skills (MS Word and Excel ... 5pm Summary: The position will support the clients and Medical Practices of HCSWNY, and responsibilities will include, but...on insurance company denials on a timely basis + Review of all claims for accuracy +… more
- Canon USA & Affiliates (Albany, NY)
- …of the business unit. + Support regulatory activities by managing image quality review with external medical experts, providing clinical expertise, and reviewing ... **Mgr Medical Affairs - Clinical Development Sr - HIT...and external experts. Support marketing in developing collaterals and review of collaterals for clinical accuracy and adherence to… more