- Humana (Albany, NY)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- CVS Health (Albany, NY)
- …(if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- Elevance Health (East Syracuse, NY)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an… more
- Molina Healthcare (Rochester, NY)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …guidance and plans they need for healthy living. Outreach and Retention Associate (ORA)- Medicare Advantage CPHL is a Medicare Advantage Prescription Drug plan ... orient them on the CPHL benefits and health delivery system access. + Conduct daily surveys to members who...eligible for, + Answer inquiries related to all CPHL Medicare products *Licensed Agents Only. + Educate potential members… more
- Molina Healthcare (NY)
- …with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes or healthcare compliance requirements **Ideal Candidate Attributes** + **Curious ... Adjustment Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to...the generation of chart retrieval chase lists based on CMS audit samples and internal data logic. + Use… more
- Healthfirst (NY)
- …guidelines. + Prepares and submits marketing materials to State agencies and/or CMS for review and approval. + Coordinate with internal departments regarding the ... Provides support to all internal stakeholders during the annual Medicare Go to Market project in preparation for the...plan) + Knowledge or prior experience using ePACES and/or CMS -MARx + Healthfirst product knowledge of MLTC and MAP… more
- Molina Healthcare (Albany, NY)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Humana (Albany, NY)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Humana (New York, NY)
- …Bachelor's degree + 10 plus years' experience in health insurance operations, complaint management , and CMS STARs programs (experience in large national insurers ... serve as a strategic leader overseeing initiatives to improve CMS STAR ratings and manage Complaint Tracking Metrics (CTMs)...annual revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices… more