- Merck (Albany, NY)
- …Skills:** Accountability, Accountability, Adaptability, Audits Compliance, Business Processes, Clinical Documentation , Clinical Quality Management, ... and saving lives around the world. Our Research & Development Division QA Clinical Quality (CQ) provide independent assurance that our Company ensures the safety,… more
- CVS Health (Albany, NY)
- …Eastern and Central time zones._ **Job Summary:** The NCQA Accreditation Auditor is responsible for evaluating healthcare organizations' compliance with NCQA ... and supporting quality activities. This role involves conducting audits, preparing documentation , and collaborating with internal teams, as well as external… more
- Datavant (Albany, NY)
- …audits. + Develop and implement education for physicians, nursing, and other clinical staff to enhance documentation . + Communicate effectively with co-workers, ... the future of healthcare from your own workspace! Inpatient auditor with 3-5 years of experience at a Trauma...assess proper coding or identify the need for additional documentation . Scrutinizes all HCPCS and CPT codes influencing APC… more
- SUNY Upstate Medical University (Syracuse, NY)
- …OB/GYN encounters. This position serves as a key liaison between coding, clinical , and compliance departments ensuring that all documentation and coding ... The role also includes providing ongoing education to OB/GYN providers and clinical staff on documentation quality, coding updates, and best practices… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and represents non- clinical staff in discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new ... of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud, waste and abuse (FWA) for all lines of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …implements process improvement to increase efficiency in the review process for the clinical staff. + Works with requesting providers, clinical pharmacists, and ... Triages prior authorization workflow daily by rerouting cases, alerting clinical staff of time frame deadlines, monitoring work queues...of business in the day-to-day work. Serves as internal auditor within the group to report issues to management… more
- Spectrum Health and Human Services (Orchard Park, NY)
- …CCBHC model. + Participate in internal and external audits, preparing schedules, documentation , and responding to auditor requests. + Reconcile general ledger ... requirements, and specific CCBHC funding rules. + Collaborate with clinical and program teams to ensure proper allocation and... and program teams to ensure proper allocation and documentation of program expenditures. + Support grant invoicing and… more
- Molina Healthcare (Yonkers, NY)
- …of department interventions. + Creates, manages, and/or compiles the required documentation to maintain critical quality improvement functions. + Leads quality ... Excel and Visio (flow chart equivalent). **Preferred Education** Preferred field: Clinical Quality, Public Health or Healthcare. **Preferred Experience** 1 year of… more
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