- Ankura (Lexington, NY)
- …is a team of excellence founded on innovation and growth. Ankura's Disputes & Economics professionals are world class and globally recognized independent experts ... who tailor financial, operational, and compliance solutions to complex litigation, enforcement, and regulatory challenges....Director will support the Healthcare Payer team within Ankura's Disputes & Economics practice - one of seven practices… more
- Ankura (Lexington, NY)
- …A recognized leader in healthcare litigation support, Ankura's Healthcare Disputes team combines unparalleled clinical, technical, and operational experience with ... analytical offerings for our clients that reveals how this information impacts legal disputes that these companies may be facing. We combine in-depth operational, … more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** Code Edit Disputes team reviews and educates providers when there is a dispute on ... millions of people we serve to achieve their best health - delivering the care and service...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Western Digital (Albany, NY)
- …in data. **Job Description** **Position Summary** We are looking for a **Retail Compliance Specialist** to join the Western Digital Fulfillment Operations Team to be ... strong communication skills. **Essential Duties and Responsibilities:** + Experience with retail compliance and penalty programs (eg, Walmart's OTIF - On Time In… more
- Molina Healthcare (Albany, NY)
- …to review compliance -based issues for benefit planning purposes. **Recoveries & Disputes ** + Review and validate provider complaints and payment disputes , ... disputes , appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical...years of experience in previous roles in a managed care organization, health insurance or directly adjacent… more
- Intermountain Health (Albany, NY)
- …investigating, coordinating and managing legal insurance cases and represents Intermountain Health in OIG hearings and 1st level grievances with insurance companies ... levels of internal and external personnel and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various… more
- CVS Health (Albany, NY)
- …consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions ... At CVS Health , we're building a world of health...+ Negotiate and manage contracts with pharmaceutical manufacturers, ensuring compliance , tracking performance metrics, and resolving disputes .… more
- New York State Civil Service (Albany, NY)
- …Manage the carrier invoice dispute process, including opening and closing disputes based on validation of monthly-recurring invoices.* Process non-recurring invoices ... This involves validating against approved ITSM requests and ensuring contract rate compliance . ITSM Processing and Technical Support* Process and close ITSM requests… more
- YAI (Ulster County, NY)
- …to the community. + Responsible for the overall supervision, protection, and care of individuals at all times including maintenance of program guidelines for ... signs of an individual's potential harm to self or others. + Ensures health , wellness and safety by providing appropriate supervision of the people we support… more
- Humana (Albany, NY)
- …we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...improvements in quality and/or reductions in total cost of care . + Scorecard creation and reconciliation of provider performance… more
- Humana (Albany, NY)
- …we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These ... part of our caring community and help us put health first** Join Humana-recognized as a Fortune Top Company...improvements in quality and/or reductions in total cost of care . + Design and develop data models to attribute… more
- Amrize (Ravena, NY)
- …+ Health Savings Accounts (HSAs) & Flexible Spending Accounts (FSAs) for health and dependent care + Vision and other Voluntary benefits and discounts ... objectives and oversee quality control. **WHAT YOU'LL ACCOMPLISH** + Ensures Health , Safety and Environmental values, policies and standards are maintained and… more
- Sedgwick (Albany, NY)
- …Suite (Excel, Word, Outlook). + Ability to negotiate settlements and resolve claims disputes effectively. **TAKING CARE OF YOU** + Flexible work schedule. + ... and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. + Acts… more