- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- University of Rochester (Rochester, NY)
- …to: telephone, photocopy machine, adding machine, personal computer (for claims inquiry and entry software) fax/scanner, Flowcast billing application, Microsoft ... Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro) and various payer web sites. **Typical Duties:** 30%… more
- FlexStaff (Chappaqua, NY)
- …and patients by telephone or online and appealing denied or incorrectly paid claims . Key Responsibilities: - Review insurance payments for accuracy based on ... Number** 159695 FlexStaff Our client is seeking a skilled Medical Biller/Accounts Receivable Specialist with a minimum of 2...- Prepare and submit appeals for underpaid or denied claims - Follow up with insurance carriers regarding outstanding… more
- Humana (Albany, NY)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- EAC Network (Garden City, NY)
- …with program directors, develop plans to address variances. + Process and submit claims requests within 10 business days of the end of each reporting period. ... external funder systems and kept current for use in claims and projections. + Collect and verify key cost...and accurate submission of reimbursement requests to funders. + Review all vouchers before submission + Compliance and Close-Out… more
- University of Rochester (Rochester, NY)
- …assigned. Qualifications: - Required: Associates Degree and 4-5 years of professional medical claims billing and collecting experience; or equivalent combination ... paper claims with appropriate attachments when needed (insurance EOB, medical records, etc.). Ensures additional documentation and/or information is provided for… more
- Mount Sinai Health System (New York, NY)
- …Cycle Manager. **Qualifications** + Associates Degree preferred + 5 years experience in medical billing or health claims , with experience in IDX billing systems ... Receivable, Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and assists with… more
- Sedgwick (Albany, NY)
- …you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your ... of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Humana (Albany, NY)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + ... Coding Educator is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with providers to enhance… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as needed. + Ensures that the medical care ... standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those...Behavioral Health medical directors reviewing pediatric cases review those cases in accordance with Company policies. +… more