- 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
- Saratoga Hospital (Saratoga Springs, NY)
- …state, federal and accreditation requirements, including but not limited to the Centers for Medicare and Medicaid ( CMS ) and the Joint Commission (JC), DNV, OSHA, ... our community. As part of the Albany Med Health System , we combine advanced technology with a deeply personal...to identified trends. + Assists with overall regulatory program management and maintains current working knowledge of the Hospital's,… more
- Arnot Health (Elmira, NY)
- …on interpretation of regulatory standards, including The Joint Commission and Centers for Medicare and Medicaid Services ( CMS ); ensures a constant state of ... responsibility for quality improvement and compliance for the Arnot Health System . ** 2. Directs all organizational continuous accreditation readiness activities. **… more
- Trinity Health (Albany, NY)
- …documentation improvement specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as ... well as a deep understanding of CMS guidelines, and other regulatory requirements are essential. Strong...in the risk adjustment model in which the healthcare system participates. + Formulates compliant queries following Trinity Health's… more
- Ellis Medicine (Schenectady, NY)
- SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This position works with the ... Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration with physicians and social workers for care… more
- Community Wellness Partners (Oswego, NY)
- …accounting, particularly within the skilled nursing sector, including Medicare /Medicaid reimbursement, cost reporting, and regulatory compliance. Key ... cash, AR, AP, fixed assets, and accruals. + Ensure compliance with GAAP, CMS guidelines, and other healthcare industry accounting standards. + Support Medicare … more
- Molina Healthcare (Yonkers, NY)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- Intermountain Health (Albany, NY)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more
- Molina Healthcare (Yonkers, NY)
- …for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare , and Marketplace lines of business. This includes direct management ... to support efficient and compliant subrogation operations across Medicaid, Medicare , and Marketplace populations. + Collaborate with legal, claims, provider… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …work operations by documenting and communicating needed actions to management ; discovering irregularities; determining continuing needs for Tele-Sale Agents, Benefit ... Navigators and Medicare Support Specialist. + Ensure all Tele-sale Agents, Benefit...Specialists are conducting activities that are in compliance with CMS /DOH and company guidelines by directly reporting to the… more