- Molina Healthcare (Buffalo, NY)
- …operations. + Maintain fluency in healthcare data types (eg, ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions. REQUIRED EDUCATION: + ... Bachelor's or Associate's degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields **REQUIRED EXPERIENCE / SKILLS:** + 3-5 years of experience working with **healthcare data** in an analytics or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and other high-risk issues. * Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments. * Collaborate with Case Management on ... the status of high-risk member referrals. * Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home. * Communicates health insurance program options, fundamentals of all the health… more
- CenterWell (Albany, NY)
- …required pharmacy or clinical management systems + Support CMS Stars and HEDIS quality measures for successful clinic performance + Maintain accurate and thorough ... documentation of clinical interventions and patient care activities + Conduct in-service education and training sessions for healthcare staff as well as develop and disseminate educational materials related to pharmacotherapy + Stay current with advancements… more
- St. Mary's Healthcare (Amsterdam, NY)
- …with the Compliance and Privacy Officer. . Oversees insurance, auditing reviews (ie, HEDIS and /Risk Adjustment), to ensure staff is completing requests in a timely ... manner. . Provides on-going EMR education to providers and staff. Serves as technical expert in health record content and documentation requirements. Utilizes several databases, electronic forms management systems and software to perform required tasks. .… more
- Catholic Health (Williamsville, NY)
- …certification preferred. + Knowledge of Patient Centered Medical Home, with MIPS, HEDIS requirements preferred WORKING CONDITIONS: + Work is demanding and stressful ... at times + Visual and auditory acuity are essential + Works indoors in a well-lit, well ventilated area + May be exposed to communicable diseases + On-call coverage. REQNUMBER: 35623 more
- Molina Healthcare (Yonkers, NY)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... financial terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such… more
- Mount Sinai Health System (New York, NY)
- …Medicare regulations and related reporting requirements, such as STARS,QARR, MMCOR, MEDS, RAPS and HEDIS is a strong plus. + Experience working in a health plan or ... consulting actuarial, financial reporting or medical economics departments highly valuable. + Experience as a nurse informaticist highly valuable. + Experience working in healthcare provider analytics related to revenue modeling, managed care contracting,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …decision-making, and problem-solving skills. + Knowledge of credentialing, quality, NCQA/ HEDIS /CMS and/or Medicaid Star Ratings, and/or value-based payment programs ... is a plus. + Strong verbal presentation skills to lead internal and external discussions including presenting at board level when requested. + Previous experience managing physicians, nurses or employees preferred. + Service marketing, sales and business… more
- Molina Healthcare (Syracuse, NY)
- …and Claims applications -_** **which underpin essential business functions such as HEDIS reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure ... Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you are interested in applying for this position, please apply through the… more
- Mount Sinai Health System (New York, NY)
- …Medicare regulations and related reporting requirements, such as STARS,QARR, MMCOR, MEDS, RAPS and HEDIS is a strong plus. + Experience working in a health plan or ... consulting actuarial, financial reporting or medical economics departments highly valuable. + Experience as a nurse informaticist highly valuable. + Experience working in healthcare provider analytics related to revenue modeling, managed care contracting,… more