• Compliance Auditing Specialist- Remote/Hybrid…

    WMCHealth (Valhalla, NY)
    …Coder (CRC), Certified Professional Coder certification (CPC), Certified Professional Medical Auditor (CPMA) or Certified Clinical Documentation Specialist ... coding improvement activities. Monitors and reports key performance indicators relative to clinical documentation and HCC coding. . Documents and maintains… more
    WMCHealth (09/12/25)
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  • Clinical Denials and Appeals-…

    Catholic Health (Buffalo, NY)
    …denied claims denied due to reasons including, but not limited to clinical documentation /support for diagnostic related grouping (DRG) assignment, inpatient and ... patient care team on an ongoing basis in relation to trends in denials, and clinical documentation to influence behaviors to assist in the reduction of ongoing… more
    Catholic Health (10/01/25)
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  • Asst Dir, Qual & Reg Assr, Clinical Trials

    University of Rochester (Rochester, NY)
    …considerations._ **Responsibilities:** General Purpose Leads the Quality Assurance team for clinical research conducted at CHeT. Ensures clinical data quality, ... regulatory compliance, and integrity of research documentation while collaborating with internal leaders and Principal Investigators. Ensures that CHeT is … more
    University of Rochester (08/07/25)
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  • Medical Investigator I/II

    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 (09/17/25)
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  • Case Manager, RN (Commercial)

    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 (09/30/25)
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  • Pharmacy Revenue Integrity

    Albany Medical Center (Albany, NY)
    …analytical skills + Can work proficiently in Excel, EPIC and ADMs + Strong clinical knowledge and clinical documentation practices + Excellent verbal and ... of the Director of Pharmacy the Pharmacy Revenue Integrity Auditor will serve as a pharmacy liaison and interface...as requested, and will be responsible for maintaining relevant documentation and records. They will remain current with important… more
    Albany Medical Center (08/14/25)
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  • Compliance Analyst II, Urmc and Affiliates

    University of Rochester (Rochester, NY)
    …investigation, collects and analyzes documents, data, electronic records, billing and clinical documentation , and other relevant materials. Conducts interviews ... Coding, and Education Analyst** Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and… more
    University of Rochester (10/03/25)
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  • Specialist, Member & Community Interventions…

    Molina Healthcare (Yonkers, NY)
    …The Specialist, Member & Community Interventions implements new and existing clinical quality member intervention initiatives including all lines of business ... of department interventions + Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverables +… more
    Molina Healthcare (09/27/25)
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  • Sr. Accountant

    Robert Half Finance & Accounting (Orchard Park, NY)
    …for the model. * Participate in internal and external audits, preparing schedules, documentation , and responding to auditor requests. * Reconcile general ledger ... state requirements, and specific 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
    Robert Half Finance & Accounting (10/03/25)
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  • CCBHC Accountant

    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
    Spectrum Health and Human Services (10/01/25)
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