- 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
- Molina Healthcare (Albany, NY)
- … claims issues. This role requires a keen understanding of medical claims processing , strong analytical skills, and the ability to effectively triage ... or team for further research or correction. + Leverages knowledge of claims processing workflows, billing practices, and regulatory guidelines to provide… more
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing Medicaid , Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, ... tools such as DSHS and Medicare billing guidelines, Molina claims ' processing policies and procedures, and other...of 1 year experience in healthcare insurance environment with Medicaid , or Managed Care + Strong verbal and written… more
- Humana (Albany, NY)
- …or team lead role. **Knowledge & Skills:** + Solid understanding of claims processing , insurance guidelines, and provider data interpretation. + Familiarity ... a part of our caring community and help us put health first** The Supervisor, Claims Review makes appropriate claim decision based on strong knowledge of claims … 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
- Humana (Albany, NY)
- …make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business… 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
- Humana (Albany, NY)
- …specified time frame. + CAS, MedHOK experience strongly preferred + Previous experience processing medical claims **Required Work Schedule** This is a remote ... Intermediate experience with Microsoft Word and Excel **Preferred Qualifications** + Associate or Bachelor's Degree + Experience handling multiple projects and… 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