- Stony Brook University (Stony Brook, NY)
- …regulations, and third party contracts, as well as the Hospital inventory management system , electronic medical record and departmental documentation programs. ... regulations, and third party contracts, as well as the Hospital inventory management system , electronic medical record and departmental documentation programs. +… more
- Ellis Medicine (Niskayuna, NY)
- …State Department of Health (NYSDOH), American College of Radiology (ACR), Centers for Medicare & Medicaid Services ( CMS ), and Joint Commission (TJC) standards + ... Complete and update all employment requirements, including all required continuing education courses, continuing experience requirements, Employee Health, Radiology competencies, and credentials + Performs all functions of the modality within the scope of… more
- Stony Brook University (East Setauket, NY)
- …+ Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... information. + Identifies issues and patterns on accounts within our financial system . + Assists in staff training and makes recommendations to improve policy… more
- CenterWell (Hauppauge, NY)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more
- Independent Health (Buffalo, NY)
- …and statistical analyses, specifically designed to support pricing and bidding for Medicare Advantage plans. Such projects will support both internal and external ... insights to enhance pricing and financial performance. + Ensure compliance with CMS regulations and risk adjustment methodologies. + Develop and execute pricing… more
- YAI (Manhattan, NY)
- …regulatory agencies (Office for People with Developmental Disabilities (OPWDD), Centers for Medicare and Medicaid Services ( CMS ), Office of Medicaid Inspector ... General (OMIG), Department of Health (DOH)), etc. + Develops monitoring tools and checklists for use in internal audits to assess compliance with applicable regulations and identify areas of concern in preparation for external audits. + Supports program… more
- Molina Healthcare (NY)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Humana (Albany, NY)
- …inventory monitoring and assignment of escalated inventory + Research on guidelines - CMS , AMA, etc. + Training new coders/auditors + Responsible for updating and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Robert Half Accountemps (Albany, NY)
- …representatives from commercial insurers and entitlement programs (eg, Medicaid/ Medicare ) to complete credentialing requirements. + Prepare credentialing packets, ... current across all credentialing platforms including CAQH, PECOS, NPPES, and CMS databases. + Complete revalidation requests from government payers in collaboration… more
- Cognizant (Albany, NY)
- …+ Experience making payments with UB/institutional ( CMS -1450) and/or professional ( CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage ... and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper...and external SLAs. + Other duties as assigned by management . **Qualifications:** + A minimum of 2 years' claims… more