- WMCHealth (Valhalla, NY)
- …up and maintained. + Software & Data Management + Maintain, test, and audit split-billing software and associated data feeds, ensuring accuracy and compliance. + ... Develop and refine claims qualification logic and data feeds for contract pharmacy...& Compliance Oversight + Develop and maintain a 340B audit compliance program, executing self-audits and implementing corrective action… more
- University of Rochester (Rochester, NY)
- …oversees a variety of financial activities, including accounting, financial analysis, audit , credit, collections and financial risk mitigation for the $18 million ... and datasets related to, but not limited to, enrollment, premiums, claims , payments, prescription rebates, and stop-loss insurance to ensure proper booking… more
- Independent Health (Buffalo, NY)
- …system administration and reporting, vendor delegation oversight, medical pharmacy claims processing and training. They will establish and monitor performance ... + Accountable for development and production of regulatory reporting to meet/exceed audit requirements. + Accountable for business need reporting to track metrics,… more
- New York State Civil Service (Albany, NY)
- …No Compressed workweek allowed? Yes Telecommuting allowed? Yes County Albany Street Address Audit and Quality Improvement 40 North Pearl Street City Albany State NY ... of Temporary and Disability Assistance (OTDA) reimbursement of districts' claims for payment of the expenditures of the service...providers;* Work with program areas and budget on fiscal audit issues; * Prepare for and participate in … more
- Highmark Health (Albany, NY)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Kaleida Health (Buffalo, NY)
- …(DRG) assignment, proper reimbursement and quality measure/metrics. Assists with the audit analysis, trending, and presentation of audit /review findings, ... plan and execute quality audits, perform data analysis, trending, presentation of audit /review findings, and identify opportunities and develop a training plan for… more
- New York State Civil Service (Albany, NY)
- …and maintain working knowledge of tax law as well as Department and Audit Division procedures and policies, including the Code of Conduct, Ethics practices and ... with computer equipment and case materials to various field audit sites, training classes, BCMS conferences, etc.* Represent the...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- CDPHP (Albany, NY)
- …team's delivery of the analysis, maintenance, and configuration of CDPHP's core claims systems and applications application systems, as well as modifying existing ... state and federal mandates to ensure the successful configuration of CDPHP's core claims systems and any integrated systems. The Configuration Analyst III will be… more
- M&T Bank (Getzville, NY)
- …might occur in the near future. + Respond to FHA demands, including BCDE Claims , and all other claims besides principal. Provide additional documentation as ... in cases where HUD denied an over-allowable request. + Liaise with Accounting, Claims and Foreclosure groups. + Complete insurance claims for damaged properties… more
- Molina Healthcare (NY)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... timely manner to meet department standards of turnaround time and quality. + Audit loaded provider records for quality and financial accuracy and provide documented… more