- Cardinal Health (Albany, NY)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... timely manner. The Coordinator, Individualized mediates effective resolution for complex payer /pharmacy issues toward a positive outcome and provides a positive… more
- The Institute for Family Health (New Paltz, NY)
- …vendors}) + Ensures smooth operations with clearinghouse vendor and facilitates payer requirements as needed for electronic claims processing and retrieval of ... 28, Article 31, dental CMS, managed care, sliding fee, and commercial payer billing guidelines and regulations. + Understanding of the implications of facility/group… more
- Regeneron Pharmaceuticals (Sleepy Hollow, NY)
- …commercialization activities, including the preparation of HTA submissions and addressing payer requirements. * Evaluate HTA decisions and apply insights to pipeline ... and marketed products, ensuring submissions meet regulatory and payer expectations for value demonstration and reimbursement. * Report, publish, and present HEOR… more
- Adecco US, Inc. (Utica, NY)
- …and appeals, ensuring timely patient access. 3. Design and deliver advanced payer insights tailored to provider needs, incorporating evolving policy trends and ... 7. Serve as a subject matter expert on Medicare and commercial payer structures, translating complex benefit data into actionable insights for stakeholders. 8.… more
- Mount Sinai Health System (New York, NY)
- …monitoring provider sanctions from regulatory agencies, participation status with payer programs, and other demographic and credentialing and contractual ... (ie, FEHBP, OIG, OPMC, etc.). 3. Participates in department activity for any payer initiatives related to provider data veracity and exchange. 4. Participates in… more
- CVS Health (Albany, NY)
- …5+ years Program Management experience leading complex initiatives within the payer clinical space + Strong interpersonal and communication skills, effectively ... risk management, product strategy, regulatory policy + Broad understanding of the payer landscape with ability to synthesize multiple disparate data points into a… more
- Heath System Services (Niagara Falls, NY)
- …orders. Billing and Insurance Compliance: + Ensure all orders meet payer requirements, including benefit verification, medical necessity qualification, and prior ... authorization. + Maintain adherence to Medicare, Medicaid, and commercial payer standards. + Act as a resource for billing and coverage policy questions from team… more
- Teresian House (Albany, NY)
- …billing for Medicare, MCO's, Medicaid and private insurers using electronic and payer formats. Monitor and manage outstanding balances and follow-up on unpaid ... + Working with other departments to ensure accurate census date and payer sources are maintained. + Assisting with audits and providing requested documentation… more
- Oak Orchard Health (Brockport, NY)
- …with the third-party billing organization to ensure proper processing of all payer claims. This would include research for accuracy, analyze reports, follow through ... Participate meetings with third party billing organization and insurance payer representatives, as needed, + Stay apprised with billing/coding updates… more
- Finger Lakes Health (Geneva, NY)
- …outstanding information/co-payments on the date of service. Responsibilities also include: Verifying payer coverage of the services to be provided to the patient, ... Pre-certifying the service with the payer , Obtaining any required pre-authorization(s), and documenting all information related to the certification/authorization.… more