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As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics.
$140,000 - $160,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data. Additional recent significant cases include the indictment and arraignment of the owner of an NYC pharmacy for allegedly stealing millions from Medicaid; the sentencing of a Bronx clinic owner for defrauding New York State out of more than $4 Million in false Medicaid claims; and the extradition, arrest, and arraignment of a Medicaid fraud ringleader.
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Manage and lead the revenue cycle management team and processes, including benefits verification, claims submission, payment posting, denials management, and revenue optimization. You will be responsible for managing and optimizing the end-to-end revenue cycle operations, including benefits verification, claims submission, payment posting, denials management, and revenue optimization.
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5-7 years of experience in managed care organization compliance/auditing or healthcare compliance (experience with billing, claims process, Medicaid, Medicare, ACA, medical record review, investigation of problematic issues.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
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Manages Leave of Absence Administration for employees within the lines of business as well partners with Risk Management on Workers Compensation claims and accidents. DocGo is leading the proactive healthcare revolution with an innovative care delivery platform that includes mobile health services, population health, remote patient monitoring, and ambulance services.
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3+ years of experience in medical billing or health claims, with experience in billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment.
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Paid Time Off (PTO) Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more.
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Minimum of 3 years recent Managed Care experience in Provider Relations, Network Operations, and/or Network Management. Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards.
$86,700 - $190,700Full-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Payment Integrity Analyst / Managed Care Claims / Hybrid Position (2-3 days in Manhattan office, 2-3 days remote) Identify overpayment/underpayment opportunities through data mining, investigation, and quality reviews on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
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Exhibiting familiarity with healthcare compliance regulatory agencies and a general understanding of healthcare laws and regulations (e.g., HIPAA, CMS, Medicare, Medicaid, Affordable Care Act, Anti-Kickback, Fraud and Abuse laws, False Claims Act, Accreditation, Research and Academic Medical Center experiences); and.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Minimum of three (3) years of hospital inpatient coding experience in ICD-9 and ICD-10 diagnosis and procedure coding and DRG assignment, preferably in a tertiary care, teaching environment with complex surgical, transplant, trauma, neurosurgery, Ob/Gyn, and neonatology services.
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Goal is not volume or billing/claims: it's QUALITY. Excellent care means low hospital admissions, great preventive medicine, and a delightful patient experience. Outpatient with Geriatric focus Opportunity in NYC - Brooklyn, Bronx, QueensGroup is an innovative network of neighborhood primary care centers and is focused on providing high quality care to Seniors.
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Using MDGuidelines, which is the gold standard in clinical guidelines in this industry, the Clinical Case Manager will facilitate medically sound decisions, ensure absence and disability claims are administered effectively, and deliver compassionate care to our client employees.
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Administrative claims data, EHR/EMR data, or complex relational health care databases with significant experience analyzing medical, pharmacy, and behavioral health claims data. Horizon BCBS NJ is New Jersey's largest and #1 Rated Healthcare Managed Care Company.
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care claims jobs in Newark, NJ
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