- Molina Healthcare (Albany, NY)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Molina Healthcare (Albany, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Cardinal Health (Albany, NY)
- …+ Clear knowledge of Medicare (A, B, C, D) + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred + 1-2 years of ... preferred + Previous social work experience is preferred + LVN is preferred + 2-4 years of Case Management...to Word, Outlook, and preferred Excel capabilities + Previous medical experience is preferred **_Responsibilities_** + Deliver virtual or… more