- 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
- Highmark Health (Albany, NY)
- …the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special ... is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various… more
- Humana (Albany, NY)
- …+ Knowledge of healthcare terminology. **Preferred Qualifications** + Medical claims processing experience. **Additional Information** + **Workstyle:** Remote, ... community and help us put health first** Join Humana's dynamic team as a Claims Research & Resolution Representative and make a meaningful impact every day! In this… 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)
- …Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing , prior authorization, formulary management and clinical ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care… 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
- Molina Healthcare (Albany, 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