- Humana (Albany, NY)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized at the Inpatient ... communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or… more
- Takeda Pharmaceuticals (Albany, NY)
- …in order to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- Trinity Health (Albany, NY)
- …resolves claim edits that occur after coding to support timely final claims submission. Assigns appropriate code(s) by utilizing coding guidelines established by: + ... Patient Business Services (PBS) teams, when needed, to help resolve billing, claims , denial and appeals issues affecting reimbursement. Maintains CEUs as appropriate… more
- Humana (Albany, NY)
- …and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are ... payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes,...**What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company… more
- Humana (Albany, NY)
- …first** Humana's Clinical Analytics Team is seeking a Lead Research Scientist ( Remote ). Healthcare is rapidly changing, and our members are living longer, often ... clinical concepts and extract clinical information from medical, pharmacy, and lab claims for analytics and modeling purposes + Translates analytic results into key… more
- Humana (Albany, NY)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position \#LI- Remote **Scheduled Weekly Hours** 40… more
- Humana (Albany, NY)
- …working with health insurance operations related data to include enrollment, claims , billing and Reconciliation and/or contact center (Call center) data **Additional ... Information** **Work Style** : Remote **HireVue Statement** : As part of our hiring...(collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and… more
- Humana (Albany, NY)
- …Degree + CAS, MTV, PAAG, or APEX systems experience + Claims experience + Provider data management data loading/analysis/review **Additional information** ... ongoing interruptions to protect member PHI / HIPAA information. This is a remote position \#PPNO **Scheduled Weekly Hours** 40 **Pay Range** The compensation range… more