- 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
- Humana (Albany, NY)
- …documentation and communications. + Exceptional attention to detail and accuracy in reviewing and processing claims . + Ability to quickly adapt to and learn new ... opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent...systems and technologies relevant to claims processing . + Strong organizational skills with… 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
- Oracle (Albany, NY)
- …+ **Regulatory Compliance** : Stay current with regulatory requirements related to claims processing across payers and government entities such as CMS/state ... this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical...1-2 years of experience in hospital audits preferred + Associate or bachelor's degree in nursing from an accredited… 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
- Humana (Albany, NY)
- …2 years of Humana Experience + Knowledge of Humana Medical and Pharmacy Claims Processing Systems + Experience with data query/data programming applications (ie ... and abuse within the healthcare industry + Knowledge of the Medicare and Medicaid programs + Experience in data analysis + Must be passionate about contributing… 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