- Molina Healthcare (Rochester, NY)
- …DESCRIPTION **Job Summary** Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching ... pharmacy strategy for optimization of medication related health care... prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any… more
- Highmark Health (Albany, NY)
- …coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + ... **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree +… more
- RxBenefits (New York, NY)
- …The team also assists with resolving client issues involving performance discrepancies, claims issues, and reporting. The successful Pharmacy Pricing Senior ... In this multi-disciplinary, cross functional role, the Senior Manager, Pharmacy Pricing will report to the Director, Pharmacy Pricing & Analytics. The Senior… more
- 32BJ Benefit Funds (New York, NY)
- …Range: 54346.26 To 54346.26 (USD) Annually Job Title: Member Services Representative (Benefits Specialist) Extended Hours * *Differential Pay Added for Working ... SRSP, Shortman). + Handling of inquiries through vendors, Medical, Optical, Pharmacy , Dental and Employee Assistance. + Follow workflows to resolve participant… more
- Molina Healthcare (NY)
- …or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to ... as they arise, making an assessment when escalation to a Senior Representative , Supervisor, or another Molina department is needed. Takes initiative in preventing… more
- New York State Civil Service (White Plains, NY)
- …Yes Agency Insurance Fund, State Title Assistant Insurance Fund Services Representative Occupational Category Clerical, Secretarial, Office Aide Salary Grade 13 ... City White Plains State NY Zip Code 10601 Duties Description Working within the Claims Systems and Services Unit, the selected candidate will work on the CMS… more
- Pfizer (New York, NY)
- …Adcetris and Elrexfio. The Senior Manager will manage various data assets, including claims , sales, and specialty pharmacy data, and will work across oncology ... + **Secondary Data Analysis** : Leverage multiple external data sources (eg, claims data, specialty pharmacy data, non-retail sales) to generate actionable… more
- CVS Health (Albany, NY)
- …as well as navigating them through the health system, providing support on claims issues, and answering coverage-level questions. This role is 100% dedicated to our ... any benefits related issues including answering routine questions, addressing denied claims , preauthorization, and providing support to both the employees and the… more
- Whitney Young Health Center (Albany, NY)
- …reporting. + Provides a planned organization wide process for reporting and managing claims and lawsuits in compliance with the FTCA. Completes the required annual ... Redeeming application for FTCA coverage. + Serves as the lead WYH representative to the FTCA coverage and application process. + Responsible for receiving,… more
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