- Highmark Health (Albany, NY)
- …leadership, problem-solving, data analytics, team development, communication, implementation, and project management . The incumbent often plays a central role in the ... include elements of team leadership, problem-solving, data analysis, project management , communication, implementation, and provider and/or provider-facing team education… more
- Trinity Health (Schenectady, NY)
- …and familiarity with web based software applications. + Working knowledge of the Medicare Prospective Payment System and working knowledge of ICD-10 coding, CMG ... Sunnyview is an affiliate of St. Peter's Health Partners. **Prospective Payment System (PPS) and Quality Reporting Program (QRP) Coordinator for Sunnyview Rehab… more
- Stony Brook University (East Setauket, NY)
- …claims. + Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... Patient Accounting. + Experience in Insurance Verification. + Experience working in Medicare FSS DDE system . **Special Notes** **:** **Resume/CV should be… more
- Humana (Albany, NY)
- …data driven methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care, ... pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and...with staff in different positions and all levels of management positions. + Ability to prioritize, organizes, and executes… more
- Molina Healthcare (Albany, NY)
- …Action Items (SAIs) including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay edits, post payment ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- Elevance Health (Latham, 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 ... test is completed and meets the test plan requirements, system testing is completed, and system is...of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the… more
- Northwell Health (Lake Success, NY)
- …for all records as required and in accordance with the Centers for Medicare and Medicaid Services ( CMS ) rules and regulations. 7.Make determinations on ... online resources: Official Coding Guidelines (OCG), AHA Coding Clinic, Center for Medicare Services and CPT Assistant) to identify appropriate codes and reference… more
- Healthfirst (NY)
- …variances to budget. + Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial impacts estimations. + Respond to requests ... + Pull data from the warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) code and generate reports...community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan… more
- CenterWell (Albany, NY)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- The Institute for Family Health (New Paltz, NY)
- …Article 31, and Dental Rules and Regulations around the Medicaid and Medicare RESPONSIBILITIES: + Compile and maintain records, statistics and reports as necessary. ... + Troubleshoot billing and resolve problems with appropriate agencies, departments, and/or management + May assist with posting patient and insurance cash receipts,… more