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Technical skills in healthcare regulatory compliance, Medicare, Medicaid reimbursement, Start, HIPAA privacy laws, Fraud & Abuse and False Claims law. Develop and deploy education focused on identified business processes to mitigate the risk of noncompliance in areas vulnerable to error or noncompliance such as billing, coding, Stark laws, fraud & abuse laws, false claims or other identified risk areas.
$225,000 - $275,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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A juris doctor, master's or higher degree in a field related to the position being filled AND one year of New York State workers' compensation claims adjustor experience. One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR.
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Specific expertise in the U.S. Food and Drug Administration advertising and promotion regulations, FDCA, False Claims Act, Anti-Kickback Statute, OIG Guidance, foreign anti-bribery laws, privacy laws, and US and ex-US transparency reporting laws and industry codes (e.g., Sunshine Act, US PhRMA Code.
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The year-end Close Out Unit communicates the outcome of the claims verification process to Providers and other DOHMH units. This is accomplished by performing a limited review of claims to ensure that providers comply with the budget approved to achieve the scope of services under the contract.
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Communicates with Legal, Sales, Underwriting, Loss Prevention, Auditing, Financial on a regular basis to discuss exposures, defenses and handling of Worker Compensation Excess and Unbundled claims.
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This involves a variety of complex and technical support which includes the investigation and processing of liability claims, evaluation of policies, and responding to inquiries regarding IMC liability claims.
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This includes but is not limited to work updates, establishing publisher relationships, acting as a liaison between members, PROs and Legal Counsel to resolve conflicting claims, reconciling our data with external PROs, submission of royalty-based adjustments, and compiling income data to account for high value transactions.
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Assist with Crop claims field inspections, investigations, customer communications and administering insurance policies to ensure compliance with state and federal regulations. Support business objectives by assisting with claims auditing.
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Communicate complaints and compliments in the dining venues to the cooks and Food & Beverage Director. This individual interviews, hires and trains employees; planning, assigning, and directing work; appraising performance, rewarding and disciplining employees; addressing complaints and resolving problems.
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Prepare stop loss market RFPs for client renewal or prospective groups, to include employee census, current/renewal plan design/rate information, and historical claims experience data. Strong working knowledge of benefits insurance (broker or carrier side) as well as self-funding and stop loss reinsurance market.
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Initiates and perform audits and monitoring activities of various health plan operations, such as appeals and grievances, claims, medical management, customer service, provider relations and contracting, sales and enrollment, and other functions to ensure proper compliance with governmental regulations and health plan policies.
$77,099.34 - $92,519.21 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Address any student complaints not resolved directly by the clinic supervisor of associate. Update Touro College Clinical Manual. The Graduate Program in Speech-Language Pathology at Touro University is seeking a full time Clinical Director.
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Senior Claims Specialist - Excess Casualty. Partnering with internal and external counsel in setting and pursuing effective and cost-efficient litigation strategies for claims in litigation.
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You have 5+ years of experience selling healthcare data research assets (medical claims, prescription claims, EMR, lab data, etc.) You are a seasons consultative seller successful at uncovering and developing sales opportunities across HEOR, EPI and Commercial.
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Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
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claims complaints jobs Company: Metroplus Health Plan in Queens, NY
FEATURED BLOG POSTS
Virtual Reality Job Interviews
With the advent of desktop computers, the arduous task of scouring through weekly job classifieds became a thing of the past. The mid-1990s brought about a new era where job seekers could easily search and apply for jobs online. The introduction of AOL's Instant Messaging feature provided an even faster means for employers and candidates to communicate and schedule interviews. As smartphones became more pervasive in the early 2000s, hiring managers increasingly used phone calls for screening and interviewing candidates. Despite this trend, over 80% of interviews still took place in person.
A Potential TikTok Ban?!
As you may already know, there has been a lot of talk lately about the possibility of a TikTok ban. While this has not yet come to fruition, it's important to consider the implications this could have for businesses and recruiters who rely on TikTok as a platform to market their brand, recruit new talent, and connect with their audience.
The Effects of Workplace Racism and Sexism
One day it's a covert statement to a mother returning to work after maternity leave. Another day it's a lingering gaze at an employee enjoying a culturally rich meal. These microaggressions (or sometimes macroaggressions) can take an employee from a confident, high-performer to one that feels insecure being themselves at work. Your employees engage with people with different ideas and feel most comfortable and valued when they can work without losing their cultural, racial, and gender identity. While most employers know this, why have workplace racism and sexism often been neglected?
When Rage Applying Strikes: How to Identify Unserious Candidates
As the job market remains highly competitive, we have seen a surge in "rage applying." This is when candidates apply to multiple jobs, often without considering whether they are truly interested in the role. Rage applying goes hand-in-hand with quiet quitting. Often, employees want to entertain the thoughts and feelings of leaving their job, but they aren't necessarily serious about leaving yet. Meanwhile, other employees engaging in this trend are actually trying to find a better role. As a recruiter, it can be hard to identify who are the real applicants in a sea full of quiet quitters, but understanding rage applying and identifying red flags will certainly help.
How to Increase Job Ad Exposure
In today's competitive job market, writing quality job ads is critical for attracting top talent to your organization. While networking and candidate referrals are prime real estate for finding qualified candidates, nothing beats the tried-and-true method of writing an extraordinary job ad. But while writing a great job ad is the first step, what's more important is increasing visibility. You could have the most detailed, well-written ad on the internet, but if no one sees it, then you are wasting time (and potentially money!). Employers often believe that job boards are the root of the problem, but you can learn how to increase job ad exposure by tweaking a few steps of your recruitment process.
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.