- Molina Healthcare (Rochester, 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 (Rochester, 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
- Molina Healthcare (Rochester, NY)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- Molina Healthcare (Rochester, 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
- Independent Health (Buffalo, NY)
- …diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data . Ensure coding compliance with industry standard ICD-10-CM ... fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist- Senior will be responsible for reviewing coding and clinical decisions on… more
- Walgreens (Buffalo, 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
- University of Rochester (Brighton, NY)
- …to address concurrent DBL and WC claims ). Monitors, tracks, and maintains data for reporting requirements. Utilizes multiple systems to analyze claims , ... determined by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and internal equity… more
- Molina Healthcare (Rochester, 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
- Elderwood (Lancaster, NY)
- …timely response to claims for unemployment insurance. Verify that all termination data is reported to payroll within one pay period of termination date. + ... compliance, and related processes. + Technical Savvy:Comfortable navigating multiple systems (HRIS, ATS); familiarity with platforms likeICIMS,ADP, andUKGis a plus.… more
- Highmark Health (Buffalo, NY)
- …set in the individual gain/risk share contracts and is strategically focused on those data gaps that will result in the greatest ROI for the Organization. Further, ... the other members of the value-based reimbursement team, provider relations, senior markets, analytics, actuary and key internal/external stake holders to provide… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …across markets, addresses variations in processes and fees among region and systems with the aim of developing common approaches, and monitors provider billing ... * Supports reimbursement strategy and analysis through various duties included running data queries for analysis and evaluation of current to proposed reimbursement… more
- Fallon Health (Buffalo, NY)
- …strategic and financial goals. Responsible for compiling reports and analyzing data and making program level recommendations. Responsible for supporting PACE site ... implementation of processes and workflows, network development, contract management, claims , billing, and authorization assistance. This position may require… more