- Independent Health (Buffalo, NY)
- …will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing, ... ability to train others, to identify coding patterns and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support the… more
- Highmark Health (Albany, NY)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Independent Health (Buffalo, NY)
- …coding and documentation. The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification of the one best ... record to verify CMS HCC submission as assigned per CMS RADV audit specifications. The Analyst is going to assist the manager in training coding integrity associates… more
- YAI (Manhattan, NY)
- …Functions & Responsibilities + Reviews and interprets patient eligibility and claims data from various sources (explanation of benefits, remittance statements, ... collections reports, etc.) to assess the correctness of claims submitted for processing, identifying and communicating discrepancies, issues and/or missing… more
- CenterLight Health System (NY)
- …+ Coordinate with healthcare providers, practice managers, and coders to submit claims appropriately and timely. + Audit billing and collection procedures to ... conversion, ESRD, and Nursing Home entitlements. + Perform membership and claims analytics, including IBNR, MMR and 820/834 reconciliation. + Perform reconciliation… more
- New York State Civil Service (Albany, NY)
- …managed care organizations which includes evaluations of financial records and medical claims .* Propose solutions to the audit team regarding issues encountered ... developing a robust culture of Medicaid program integrity and healthcare compliance. Formed in 2006 to more efficiently use...during the audit . * Prepare audit work papers and reports to document scope, findings… more
- Highmark Health (Albany, NY)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- WMCHealth (Valhalla, NY)
- …up and maintained. + Software & Data Management + Maintain, test, and audit split-billing software and associated data feeds, ensuring accuracy and compliance. + ... Develop and refine claims qualification logic and data feeds for contract pharmacy...& Compliance Oversight + Develop and maintain a 340B audit compliance program, executing self-audits and implementing corrective action… more
- Highmark Health (Albany, NY)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Independent Health (Buffalo, NY)
- …system administration and reporting, vendor delegation oversight, medical pharmacy claims processing and training. They will establish and monitor performance ... + Accountable for development and production of regulatory reporting to meet/exceed audit requirements. + Accountable for business need reporting to track metrics,… more
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