- Cognizant (Albany, NY)
- ** Claims Quality Review ** ( remote ) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our ... quality standards, processes and procedures and policies + Ensures the claims processing reps adhere to predetermined quality assurance standards and the… more
- Cognizant (Albany, NY)
- ** Claims Process Executive ( remote )** **JOB PURPOSE:** Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim ... the business requirements. **ESSENTIAL FUNCTIONS** : + Examining and entering basic claims for appropriateness of care and completeness of information in accordance… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …Summary** We are seeking an experienced and dynamic Executive Director of R&D Global Quality to join our team. This pivotal role will be responsible for leading a ... global team focused on R&D Quality . This global role includes direct reports in the...be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and… more
- Molina Healthcare (NY)
- …care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk ... **Job Description** **Job Summary** The Analyst, Quality Analytics and Performance Improvement role will support...and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity… more
- Molina Healthcare (Rochester, NY)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. + Identifies and reports quality ...years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Centene Corporation (New York, NY)
- …leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining ... to utilization review , quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality … more
- CBRE (Albany, NY)
- Property Management Manager ( Remote ) Job ID 241052 Posted 06-Oct-2025 Service line GWS Segment Role type Full-time Areas of Interest Property Management Location(s) ... Remote - US - Remote - US...Vendor Management: Source, vet, and handle service providers, ensuring quality and cost-effectiveness. + Documentation: Maintain detailed records of… more
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement ... ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance… more
- Mount Sinai Health System (New York, NY)
- …and accurate integration of data from various external sources, including wholesalers, claims systems, and financial platforms. + Develop complex SQL logic to join, ... transform, and reconcile data from Epic, QS1, Oracle Cloud, 340B claims data, and wholesaler purchase feeds. + Support 340B program reporting by building custom… more
- CDPHP (Latham, NY)
- …member-focused, and community-based not-for-profit health plan that offers high- quality affordable health insurance to members throughout New York. ... The company values people, quality , innovation, and community, and its corporate culture supports...Adjustment Coding Specialist will be responsible for the chart review and ICD-10 diagnosis coding of risk adjustment eligible… more
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