- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Pharmacy Claims Representative assists local pharmacies with claims ... up and maintaining hospice/facility/ pharmacy relationships under the direction of the Pharmacy Claims Team Leaders & the Pharmacy Claims (Support… more
- Molina Healthcare (Syracuse, NY)
- **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs… more
- Mount Sinai Health System (New York, NY)
- …the WTCH clinic population. The Clinical Pharmacy Manager will act as the pharmacy representative for the WTCHP clinic(s) in coordination with other MSHS ... prescription portal for QA report and analyzing + Reviewing pharmacy claims to identify outliers, utilization and...supervisor, subject to reasonable accommodation . + Serve as pharmacy representative on behalf of MSHP as… more
- Independent Health (Buffalo, NY)
- …and paid time off (PTO), including company paid holidays. The Customer Service Representative position offers an opportunity to begin a career at Independent Health. ... the department and our family of companies. **Overview** The Customer Service Representative (CSR) is responsible for displaying confidence, passion for service, and… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …tasks; ID card production, DMR's, creation of mass mailings to membership or resolving claims not adjudicated in the mail order platform. May possess alarm code and ... issues to insure complete client satisfaction. + Provide Help Desk resolution of Pharmacy Network problems to insure complete client satisfaction. + Assist with the… more
- Molina Healthcare (Manhattan, NY)
- …or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to ... as they arise, making an assessment when escalation to a Senior Representative , Supervisor, or another Molina department is needed. Takes initiative in preventing… more
- Independent Health (Buffalo, NY)
- …clinical care management processes, member benefit structures and applications, and claims processing. + Knowledge of medical necessity criteria development, ... claims systems, clinical platforms and/or CRM applications. + Prior...team and others as designated as the HCS department representative . _Immigration or work visa sponsorship will not be… more
- VNS Health (Manhattan, NY)
- …to Fraud, Waste, and Abuse of Medicare/Medicaid services. + Collaborates with pharmacy services to review PBM activities and denial of prior authorizations, ... of care and member/provider satisfaction. + Acts as a representative of the VNS Health Plans and an advocate...physicians regarding medical policies, utilization management, gaps in care, claims editing, use of resources and quality. + Performs… more
- Pfizer (New York, NY)
- …and accuracy of data from all sources - IQVIA Laad, purchased Specialty Pharmacy Data, Payer and Reimbursement data, etc. + Responsible for supporting the ... as chargeback trending, customer buying behavior and 3rd party claims data all utilized within excel or tableau +...please do not hesitate to contact your Talent Acquisition representative . **EEO & Employment Eligibility** Pfizer is committed to… more
- Pfizer (New York, NY)
- …a range of real world data such as hospital chargemaster data, EHR, medical or pharmacy claims , patient registries, PROs or other data sources + Ability to ... this matter, please do not hesitate to contact your Talent Acquisition representative . **EEO & Employment Eligibility** Pfizer is committed to equal opportunity in… more