Claims Coding Analyst handling claims editing and provider disputes at Healthfirst. Ensuring policy compliance with CMS and other coding guidelines while leading continuous improvement initiatives.
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Healthfirst
Currently Hiring
About the company
Healthfirst believes that every New Yorker deserves access to the best available healthcare.
As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members.
Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first.
Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage.
Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans.
For more information on Healthfirst, please visit healthfirst.org.
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14 jobs found
Bilingual Care Manager evaluating members’ care needs and promoting quality outcomes in New York. Collaborating with care teams and community providers to address health outcomes and member engagement.
Administrative Assistant providing secretarial support and managing tasks in a corporate setting. Handling confidential information, scheduling activities, and interacting with senior leadership.
Scrum Master managing complex enterprise - level programs for Healthfirst, providing Agile coaching and supporting product owners across projects. Fostering communication and facilitating Scrum events.
Director of Utilization Management overseeing clinical operations to ensure quality care and efficiency. Leading teams through strategic direction and compliance in a regulated environment.
Manager overseeing risk score accuracy for Healthfirst's Medicaid products, developing forecasting models and communicating financial results to senior management. Collaborate with clinical leaders to track performance metrics.
Senior Manager overseeing Clinical Utilization Management operations at Healthfirst. Ensuring compliance and excellence in medical necessity reviews and service authorizations.
Director of Performance Improvement responsible for PI initiatives and team leadership at Healthfirst. Collaborating with operations to enhance business processes and productivity measures.
Manager of DSE Provider Network Operations leading specialists in quality assurance and contract management. Driving process improvements and managing relationships within corporate departments.
Peer Support Specialist utilizing lived experience to support Healthfirst members with mental health and substance use challenges through field visits and telephonic assistance.
RN Care Manager collaborating on patient care management and coordinating with healthcare providers. Focused on improving patient outcomes in a hybrid work setting.
Manager Assessment Nurse at Healthfirst overseeing health services in New York's not - for - profit sector.