- Guidehouse (New York, NY)
- …**Travel Required** **:** None **Clearance Required** **:** None This position is fully remote **What You Will Do** **:** + Under the direction of the Director ... services through efficient review and timely resolution of assigned Medicare and third party payer accounts that are subject...hold edits, and claim denials. **This position is 100% remote ** .Daily duties for this position include: + Responsible… more
- Molina Healthcare (NY)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- Datavant (Albany, NY)
- …to realize our bold vision for healthcare. As an **Inpatient Auditing Specialist ** you will be instrumental in addressing consulting and educational needs related ... presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help...workspace! **Preferred: In need for a FT IP auditing specialist . Auditing specialist will be responsible for… more
- Zurich NA (Albany, NY)
- Sr. Claims Specialist (Workers Compensation, NE Region) 129546 Zurich is looking for an accomplished Workers Compensation Sr. Claims Specialist for or our ... hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup based in one of the following states: Connecticut, Delaware, Maine,… more
- Highmark Health (Albany, NY)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- Cardinal Health (Albany, NY)
- ** Remote Hours: M-F 8:30-5:00 pm EST (or based on business needs)** **_What Contract and Billing contributes to Cardinal Health_** Contracts and Billing is ... + Submitting medical documentation/billing data to Commercial (MCO) and government ( Medicare /Medicaid) providers + Denials resolution for unpaid and rejected claims… more
- Cardinal Health (Albany, NY)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of...hours of Monday-Friday, 7:00 AM to 8:00 PM CST. ** REMOTE DETAILS:** You will work remotely, full-time. It will… more
- Molina Healthcare (Rochester, NY)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and state regulatory requirements are met for ... (SAIs), including assisting and executing projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for… more
- Evolent (Albany, NY)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Northwell Health (Garden City, NY)
- …Home Care Coding Specialist -Diagnosis, COS-C Certificate for OASIS Specialist -Clinical. Remote position Job Responsibility 1.Leverages clinical expertise to ... and principals; performs coding audits for optimization. 4.Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained… more
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