- 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
- Cardinal Health (Albany, NY)
- …the right things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work within the scope of ... from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and...or third party policy. + Updates patient files for insurance information, Medicare status, and other changes… more
- Elevance Health (New York, 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
- Humana (Albany, NY)
- …of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and practitioner ... to determine if an appeal or further request is warranted. The Appeals Representative 4 IRT (Internal Review Team) + Review documents + Building cases +… more
- Fresenius Medical Center (Vestal, NY)
- …coordinate insurance options: + Educates on the availability of alternative insurance options (ie, Medicare , Medicaid, Medicare Supplement, State Renal ... and annual indigent waivers. + Discusses insurance options when insurance contracts are terminated. Responsibilities involving Medicare and Medicaid include… 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
- CenterWell (Albany, NY)
- …ability to read, write, and speak English and Spanish + Prior experience with Medicare + Experience with the Claims Administration System (CAS) + Knowledge of ... caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic… more
- Highmark Health (Albany, NY)
- …medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior ... of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a… more
- Mohawk Valley Health System (Utica, NY)
- …in order to promote financial stability within the Hospital. Experience in billing Medicare , Medicaid, Commercial Insurance , HMOs, and Worker's Comp/No Fault is ... is a plus. Core Job Responsibilities + Promotes a professional working relationship with insurance companies. Knows each payor representative and uses them as a… more