- MVP Health Care (Schenectady, NY)
- …requires innovative thinking and continuous improvement. To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical ... claims and attention to detail this is the opportunity...York** **Qualifications you'll** **bring:** + High School Diploma required. Associate degree in health, Business or related field preferred… more
- Humana (Albany, NY)
- …and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, provider data management and clinical ... all delivery for their assigned state, supporting the business goals of the Medicaid IT program. + Identifies and implements best practice changes within their… more
- KPH Healthcare Services, Inc. (Rochester, NY)
- …Care, and private billing, claim corrections and follow-up + Track and re-bill pending Medicaid accounts + Re-bill claims as needed + Identify pattern problems ... **Overview** **Scope of Responsibilities** : The Administration Billing Associate is responsible for identifying, researching, rectifying, and maintaining accurate… more
- Albany Medical Center (Albany, NY)
- …school education or equivalent + 1-2 years of experience in medical billing or medical claims processing + Working knowledge in Excel and Word + Ability to work ... credits - Complete daily review of patient accounts that are pending NYS Medicaid and/or Charity Care status - Complete monthly rejections categorized as eligibility… more
- Access: Supports For Living (Middletown, NY)
- …identified revenue cycle billing issues + Handling billing cycle review procedures for pre- processing (scrubbing) of weekly claims processing + Analyze, ... billing and processing program claims for accuracy and completeness; submit claims ...+ Maintain a working knowledge of OMH, OASAS, Medicare, Medicaid , Medicaid Managed Care and other payers'… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE CLERICAL ASSOCIATE CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE ... from the Social Security Administration for SN/SSI clients and SSP refunds and Medicaid Spend Down program payments. DARB is responsible for the collections, refunds… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …, CPT, HCPCS, ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems, claims flow, adjudication process, system edits ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- City of New York (New York, NY)
- …and Collections, Bureau of Fraud Investigation and the Office of Liens and Trusts. Processing credit card transactions for the Medicaid Pay-in program using a ... from the Social Security Administration for SN/SSI clients and SSP refunds and Medicaid Spend Down program payments. DARB is responsible for the collections, refunds… more
- Humana (Albany, NY)
- …Operations encompasses critical functions including care coordination, quality measurement, billing, claims processing , and customer service, each essential to ... Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal… more
- Humana (Albany, NY)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and ... of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience + Experience in data analysis and trend monitoring… more
- OLV Human Services (Lackawanna, NY)
- …standards. A critical part of the role involves evaluating insurance coverage, managing claims processing , and ensuring all aspects of patient care are ... with Finance to ensure patient charts are updated appropriately, if claims are denied/rejected. * Implement and maintain systems for insurance verification,… more
- Westchester Jewish Community Services (White Plains, NY)
- …Medicaid and 3rd Party Insurance. This position ensures timely and accurate processing of claims , collections, and account reconciliations to support the ... to: + Process and review billing for Managed Care, Medicaid , and Third-Party Payers, ensuring timely claim submission, editing,...are seeking candidates who possess the following qualifications: + Associate degree OR a High School diploma with at… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …and optimal revenue performance. The Billing Specialist will be responsible for processing the full lifecycle of medical claims -from charge entry and ... rejections or denials promptly. + Prepare and submit appeals for denied claims , including documentation and provider narratives as needed. + Identify and report… more
- City of New York (New York, NY)
- Job Description YOU MUST BE PERMANENT IN THE CLERICAL ASSOCIATE TITLE OR IF YOU ARE HIRED PROVISIONALLY AS A CLERICAL ASSOCIATE III, YOU MUST TAKE AND PASS THE ... CLERICAL ASSOCIATE CIVIL SERVICE EXAM WHEN IT BECOMES AVAILABLE. BFI...(OAS) is the central repository for the receipt and processing of negotiable instruments in compliance with the NYC… more
- Humana (Albany, NY)
- …Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… more
- Access: Supports For Living (Middletown, NY)
- …collections, and payment processes. + Maintain a clear understanding of claims processing , payer denials, and appeals. + Prepare recurring ... of behavioral health billing in New York State, particularly regarding Medicare, Medicaid , Medicaid Managed Care, and Commercial Insurance. Key Responsibilities… more
- Highmark Health (Albany, NY)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- CVS Health (Albany, NY)
- …Quality, CPHQ preferred. + Background in Managed Care. + Familiarity with claims processing workflows. + Experience with quality improvement, PIPs, ANE ... teams to analyze data, implement interventions, and monitor outcomes for Medicaid programs (STAR, CHIP, STAR Kids). Additional responsibilities include provider… more
- Northwell Health (Melville, NY)
- …Job Responsibility + Understanding of various insurance carriers, including Medicaid , Medicare, HMOs, Workers Compensation, No Fault, contracted and non-contracted ... demographics as well as updating payment and medical insurance information. + Processing patient payments and refunds. + Identifying medical coding mistakes, as well… more
- Molina Healthcare (Yonkers, NY)
- …health care operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) * Advanced understanding on health care ... into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced… more