- 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
- Sumitomo Pharma (Albany, NY)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Ducommun (Coxsackie, NY)
- Sr . Human Resources Generalist Provides full range of support in all areas of HR including recruiting, benefits administration, employee relations, training, ... development, orientation, data administration and documentation, talent management, HR compliance, and all related activities. Internal Communication and… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Albany, NY)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… 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
- Evolent (Albany, NY)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- Highmark Health (Albany, NY)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- Molina Healthcare (Albany, NY)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… 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
- New York State Civil Service (Albany, NY)
- …the Contracts and Claims (C&C) Unit on the application of CFR data to State Aid Letter and direct contract close-outs.* Conducting periodic internal control ... NY HELP Yes Agency Mental Health, Office of Title Senior Health Care Fiscal Analyst/ Health Care Fiscal Analyst...updates and testing.* Assist the budget staff on CFR data analysis required to conduct policy analysis related to… more
- Walgreens (West Sand Lake, NY)
- …with Company policies and procedures. + Responsible for operating pharmacy systems to obtain patient and drug information and process prescriptions. Assists ... and coaches pharmacy technicians in the operation of pharmacy systems and cashiers in the operation of the pharmacy...those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a… 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
- CVS Health (Albany, NY)
- …Salesforce. + Market and place stop loss policies, negotiating terms based upon claims data , strategy, relationships and cost avoidance/reduction efforts. + Work ... impacts for custom requests. + Manage and interpret operational data and apply to fee development and financial analysis....Meritain products and services along with strong business and systems knowledge. + Reviews work for accuracy and recommends… more
- Highmark Health (Albany, NY)
- …to all potential subrogation cases and forwards to vendor: *Assists with compiling data , charting of claims ; provides necessary support to resolve cases. ... subscribers, members, providers, internal and external customers; Processes and adjusts claims . This is a bargaining unit position. The collective bargaining… more
- Molina Healthcare (Albany, NY)
- …that internal teams and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and ... gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM… more
- Otsuka America Pharmaceutical Inc. (Albany, NY)
- …tailor solutions to support individual health needs and improve how people engage. Data is the cornerstone of our platform, connecting people and partners and ... platform across health experience services. This role requires a unique blend of systems thinking, product vision, and startup grit to translate ambiguous needs into… more
- Trinity Health (Rensselaer, NY)
- …of Quality, coordinates and implements performance analysis and reporting for Senior Leadership, Clinicians and Administrators in support of Quality Improvement ... Initiatives. + Implements data collection and reporting strategies for evaluation of key...from external facilities/organization for reporting purposes; develops and analyzes systems and support tools needed to obtain information or… more