- Molina Healthcare (Albany, NY)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Albany, NY)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Evolent (Albany, NY)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Albany, NY)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Elevance Health (Latham, NY)
- **Business Consultant Senior - Commercial Claims Data Mining** **Hybrid 1:** This role requires associates to be in-office 1-2 days per week, fostering ... and adaptable workplace. Alternate locations may be considered. The **BUSINESS CONSULTANT SENIOR ** is responsible for translating the most highly complex and varied… more
- Intermountain Health (Albany, NY)
- …of actual and budgeted contractual allowances and variances, monitoring of individual claims (logs), etc.). Interacts with HIM, PAS, and hospital finance staff as ... **Qualifications Required** + Demonstrated experience in a role requiring data analysis. + Demonstrates computer skills including spreadsheets, databases, word… more
- Cardinal Health (Albany, NY)
- …and enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and ... data to solve complex business problems on large data sets, integrating multiple systems . At Cardinal...Extensive knowledge of healthcare data , including clinical data , patient demographics, and claims data… more
- Datavant (Albany, NY)
- …designing, developing, and maintaining robust data pipelines for healthcare data including prescriptions, medical claims , MAO4, patient demographics, and ... with the other engineering teams to troubleshoot issues with API's and data exchanges between multiple systems . **What You Need to Succeed** + 5+ years Data … more
- Trinity Health (Clifton Park, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Sr Registration Associate - Clifton Park - FT/DAY** If you are looking for an administrative ... development + **Work/Life:** Mon-Fri 8:00-4:30pm **What you will do:** The Senior Registration Associate is responsible for performing and overall coordination of… more
- Molina Healthcare (Albany, NY)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more
- Elevance Health (Latham, NY)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- General Dynamics Information Technology (Menands, NY)
- …the GDIT's office at Riverview Center in Menands, NY. As a software Test Engineer Senior supporting the eMedNY Systems Integration Team, you will be trusted to ... Language (SQL) **Experience:** 5 + years of related experience **Job Description:** Senior Software Test Engineer (Manual) Seize your opportunity to make a personal… more
- Evolent (Albany, NY)
- …SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data * Using analytical tools to integrate various data ... care data including medical, pharmacy and ancillary claims data , membership data , clinical...feasible given data limitations * Understanding of data systems and the critical thinking skills… more
- Walgreens (Troy, NY)
- …by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered ... the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and… more
- Highmark Health (Albany, NY)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …- Interacts effectively with internal/external functional business units to gather data and develop documentation required for on-time submissions. - Works closely ... (Word, Excel, PowerPoint, Outlook) and familiarity with electronic document management systems (EDMS). **Competencies** See OPDC Competencies Chart (Level X) **P**… more
- Fujifilm (Albany, NY)
- **Position Overview** The accomplished Senior Corporate Compliance Specialist will support FUJIFILM's Corporate Compliance Program's operations to ensure high ... and implementation of new or updated polices, procedures, or systems to address new risk areas or to improve...action plans, and prepare related reports. + Manage transparency data collection, validation, and reporting process to ensure compliance… more
- Highmark Health (Albany, NY)
- …years with coding languages, analytical software, systems , tools and processes using claims , clinical, enrollment and provider data + 3 years of project ... office periodically for scheduled business meetings.** This job creates data -driven insights which identify actionable opportunities and/or create analytics and… more
- Trinity Health (Troy, NY)
- …grant reporting to federal, state, and local funders in conjunction with the Senior Grants Specialist, Assistant Director, and Director + Assists with maintaining ... systems for grant objective tracking, including developing new ...requests to funders when appropriate + Manages spreadsheets and/or data input for statistics and reportable data … more