- Trinity Health (Rensselaer, NY)
- …with proper documentation. - Works in colaboration with Billing Analyst on denied claims for missing prior authorization or referral within the EMR system. - ... Maintains up-to-date knowledge of referral/payer prior authorization requirements, eligibility guidelines and documentation requirements. - Communicates insurance decisions to patient. - Conducts follow up calls as necessary to physician offices, patients and… more
- Molina Healthcare (NY)
- …skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. ... Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Utilizes Power BI to display relevant reporting within a refresh cycle.… more
- Molina Healthcare (Yonkers, NY)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
- Bowman (Albany, NY)
- …and resolve any issues that may arise as it relates to disputes, or claims + Act as liaison between operations and many corporate accounting functions including but ... not limited to accounts payable, financials, timesheets, etc. + Assist with annual financial audit preparation as needed. **Success Metrics and Competencies** + Ability to work both independently and within a team environment. + Ability to effectively… more
- Molina Healthcare (Buffalo, NY)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Has direct oversight of enrollment, premium billing and reconciliation processes and all related staff + Coaches and mentors direct staff, including goal setting and score card development + Monitors and enforces compliance… more
- Molina Healthcare (NY)
- …team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data ... to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings.… more
- Molina Healthcare (Syracuse, NY)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- University of Rochester (Rochester, NY)
- …7:30 AM-4 PM Responsibilities Location Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at ... RTP are required. Remote location must be within 2 hours of RTP...as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues… more
- University of Rochester (Albany, NY)
- …to all and is a place where all can thrive. **Job Location (Full Address):** Remote Work - New York, Albany, New York, United States of America, 12224 **Opening:** ... open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Researches, corrects, resubmits … more
- University of Rochester (Rochester, NY)
- …independent decisions as to the processes necessary to collect denied insurance claims , no response accounts, and will investigate resolving billing issues. Maintain ... information at all times. Location Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at RTP… more