- Humana (Albany, NY)
- …resolution to a pending call.** The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services ... **Become a part of our caring community and help us put health first** The Claims Research & Resolution Representative 2 manages claims operations that… more
- Highmark Health (Buffalo, NY)
- …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …of Experience Required: 2+ years of claim processing experience with a Medicaid/ Medicare Health Plan. Preferred: Experience in health insurance product ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Ellis Medicine (Schenectady, NY)
- …outgoing data is accurate. + Review and resolve outstanding accounts receivable with insurance companies and patients. + Claims in dispute with payers are ... The Accounts Receivable Representative will be responsible for achieving accurate and...+ Review Billing Exception Report for Revenue Management, the Medicare system (FISS), and the claims scrubber… more
- Elevance Health (New Hyde Park, NY)
- …make an impact:** + Responds to customer questions via telephone regarding insurance benefits, provider contracts, eligibility and claims . + Analyzes problems ... **Position Title:** Customer Care Representative I **Location: Virtual:** This role enables associates...and troubleshooting. Requires limited knowledge of company services, products, insurance benefits, provider contracts and claims . Seeks,… more
- Molina Healthcare (NY)
- …to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies ... for a wide variety of inquiries and assistance involving their benefits, claims , premiums, and other areas including very complex issues. Conducts initial research… more
- Rochester Regional Health (Rochester, NY)
- …Proficient working knowledge of assigned receivable systemsiii. General knowledge of Medicare , Medicaid and insurance compliance issues preferrediv. Familiarity ... effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials… more
- Northwell Health (Melville, NY)
- …job. This is a hybrid role. Job Responsibility + Understanding of various insurance carriers, including Medicaid, Medicare , HMOs, Workers Compensation, No Fault, ... detailing patient demographics as well as updating payment and medical insurance information. + Processing patient payments and refunds. + Identifying medical… more
- University of Rochester (Rochester, NY)
- …will make independent decisions as to the processes necessary to collect denied insurance claims , no response accounts, and will investigate resolving billing ... as well as contact payer representatives to research/resubmit rejected claims to obtain and verify insurance coverage.... Coverage tab), review payer website, or contact payer representative as to why claims are not… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Interacts with Operations, Enrollment and Billing, Customer Care, Claims , Advocacy, Clinical Operations, Medical Affairs and Finance/Underwriting Departments ... process review. * Attends meetings and/or trainings as a representative of the Account Service Team and shares the...pressures and demands. * Ability to complete required internal Medicare Training per Center for Medicare Services… more