- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- Molina Healthcare (Albany, NY)
- **Job Description** **Job Summary** Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. ... on the claims transactional system and COB tracking database. + Review of claims identified for overpayment recovery. **Job Qualifications** **REQUIRED… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- CVS Health (Albany, NY)
- …research, analyze and document analytic leads or referrals to send for investigative review . + Review company clinical and payment policies to determine the ... impact of the scheme on Aetna business. + Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. + Communicate with colleagues, verbally and in writing, findings related to data analysis… more
- S&P Global (New York, NY)
- **About the Role:** **Grade Level (for internal use):** 13 **Director - Review Officer, Corporates & Infrastructure - S&P Global Ratings** **The Team:** The ... expertise + Previous experience in analytical quality assurance, validation, or review functions within financial services + Demonstrated ability to influence… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- DHL Express, Inc. (Jamaica, NY)
- …and procedures. DHL's continued success relies upon this role's ability to review , interpret and implement existing and new DHL policies. **Key Responsibilities:** + ... Manages import and export compliance activities in the US gateway environment in an efficient and cost-effective manner + Develops and maintains relationships with CBP, offering operational advise and identifying unities for operational and compliance… more
- City of New York (New York, NY)
- …(1) Admin Staff Analyst NM III to function as a(n) Executive Director, Financial Review & Claims Processing who will: - Manage, plan and develop the operational ... activities of DFRP, ICP and SNAP-CR Directors as they administer their specific program areas which are responsible for initiating adverse actions on cash assistance cases due to information obtained via computer matches, sanctioning individuals who fail to… more
- City of New York (New York, NY)
- …and knowledgeable experts. The DOC seeks to recruit a Director of Internal Audit Review unit. The selected candidate will be responsible but not limited to the ... following; -Directing and administering the auditing activities of an agency based on identified risk assessments; -Working with the Auditing division or other organizational unit with an auditing, accounting, or financial function, including execution of… more