- MVP Health Care (Schenectady, NY)
- …organizational and analytical skills. + Ability to utilize various data management tools to help identify potentially fraudulent activity. + Possess knowledge ... Job Skills:** + Working knowledge of Macess, Facets, CareRadius, Cognos, CMS web sites, and Encoder-Pro. **Your key responsibilities:** + Conduct clinical… more
- Banco Popular Puerto Rico (New York, NY)
- …and management . + Strong proficiency inHTML, CSS, JavaScript, and CMS platforms (MODX preferred). + Proven design skills with a portfolio demonstrating ... blends creative design expertise with front-end development and technical website management . The position ensures the website is visually compelling, technically… more
- Humana (Albany, NY)
- …by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from inpatient or post-acute care… more
- Rochester Regional Health (Rochester, NY)
- …Days SUMMARY: Review all inpatient medical necessity denials for the health system based on InterQual and/or CMS guidelines. Responsibilities include managing ... Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week:...review the denials that do not meet InterQual and/or CMS guidelines for his/her recommendation regarding appeal options. +… more
- Mount Sinai Health System (New York, NY)
- …+ In-depth knowledge of the coding process, coding systems software, workflow management , and excellent navigation of electronic medical records + Experience and ... working knowledge of various Health Insurance including CMS guidelines + Advanced knowledge of the ICD-10 CM/PCS...and billing rules + Previous experience with EPIC EMR system + Strong clinical and analytical skills to evaluate… more
- ZOLL Medical Corporation (Mineola, NY)
- …sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management - system /) (Heart Failure Management system ... CMS At ZOLL, we're passionate about improving patient...duties include selling the value of the ZOLL Patient Management System (ZPM) to clinicians as well… more
- Molina Healthcare (Rochester, NY)
- …average hold time are compliant with Centers for Medicare and Medicaid Services ( CMS ) regulations. * Ensures that adequate staffing coverage is present at all times ... for review. * Assures that activities and processes are compliant with CMS , National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and… more
- St. Mary's Healthcare (Amsterdam, NY)
- …times to meet established KPIs. + Ensure effective workflows for coding, query management , and charge capture. + Collaborate with IS and HIM to optimize the ... computer-assisted coding, EMR integration, and auditing tools. + Maintain compliance with CMS , OIG, and other regulatory guidelines + Oversee routine internal and… more
- Fresenius Medical Center (Rochester, NY)
- …dialysis machine alarm testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . + Ensure that all blood spills are immediately ... slips/invoices + Inventory for Patients + Assists patient with supply management and contacting customer service **PHYSICAL DEMANDS AND WORKING CONDITIONS:** The… more
- Molina Healthcare (NY)
- …Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services ( CMS ) standards. * Provides coordination and processing of pharmacy prior authorization ... and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and… more
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