- Molina Healthcare (Buffalo, NY)
- …and distribute standard reports on schedule + Position reports to AVP, Payment Integrity Analytics **JOB QUALIFICATIONS** **REQUIRED EDUCATION** : + Bachelor's ... and/or Project management experience. + Managed Care experience - **_specifically within Payment Integrity , Claims Payment , Provider Relations Experience_**… more
- Molina Healthcare (Buffalo, NY)
- …work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/ program management. **Job ... of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Leads and… more
- Molina Healthcare (Buffalo, NY)
- …This role focuses on identifying and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will ... lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization… more
- Molina Healthcare (Buffalo, NY)
- …workflows and controls across intake, adjudication, adjustments, appeals/grievances, and payment integrity . + Technology Enablement: Oversee requirements, ... (Healthcare/Claims)** + Deep understanding of claims lifecycle, EDI transactions, payment integrity , provider data, appeals/grievances, and audit/compliance… more
- Molina Healthcare (Buffalo, NY)
- …level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to ... + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs,… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …Summary The Billing Specialist plays a critical part in maintaining the financial integrity of the practice by ensuring accurate and efficient billing and revenue ... of medical claims-from charge entry and claim submission to payment posting, denial management, and patient billing. Duties and...on past due accounts as directed by the Billing Manager . + Maintain strict confidentiality of patient health and… more