- Humana (Albany, NY)
- …and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, provider data management and clinical ... all delivery for their assigned state, supporting the business goals of the Medicaid IT program. + Identifies and implements best practice changes within their… 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)
- …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)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and ... of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience + Experience in data analysis and trend monitoring… more
- Humana (Albany, NY)
- …Clinical Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… 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
- CVS Health (Albany, NY)
- …Quality, CPHQ preferred. + Background in Managed Care. + Familiarity with claims processing workflows. + Experience with quality improvement, PIPs, ANE ... teams to analyze data, implement interventions, and monitor outcomes for Medicaid programs (STAR, CHIP, STAR Kids). Additional responsibilities include provider… 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
- Trinity Health (Albany, NY)
- …organization or other health care financial service setting, performing medical claims processing , financial counseling, financial clearance, accounting or ... to Lead Patient Access Concierge. **What you will need:** + High school diploma. Associate degree in preferred. + One to three (1-3) years experience within a… more