- Novo Nordisk Inc. (Poughkeepsie, NY)
- …level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems, and Local Clinics and uses this to identify business opportunities… more
- Humana (Albany, NY)
- …management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience ... focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- Humana (Albany, NY)
- … first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- HCR Home Care (Plattsburgh, NY)
- …services and be able to problem-solve effectively. + Possess knowledge of the Medicare guidelines governing home health agencies. + Organized, ... shared responsibility for the overall provision and coordination of home health services provided to the HCR...as appropriate, to ensure proper coordination of care. + Review and approve all interim orders before they are… more
- Truecare Homecare Agency (Queens, NY)
- …Office Suite & HHA exchange is preferred + Understanding of regulations governing the home care field, related to Medicare , Medicaid and other insurance. + ... Company Overview: Empowering Health , Enriching Lives: True Care's Enduring Mission At...stand as a beacon of compassion and excellence in home healthcare. With a profound commitment to enhancing the… more
- Albany Medical Center (Albany, NY)
- …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
- Ultimate Care Inc (Brooklyn, NY)
- …years of experience in Medicaid, Medicare , Billing and Collections in a home health care setting + Strong knowledge of Medicaid regulations and reimbursement ... Generate and send invoices to private pay clients for home health services provided. + Payment Processing:...be covered and obtain necessary patient signatures. + Reimbursement Review : Review Medicare reimbursement schedules… more
- Heritage Ministries (Greenhurst, NY)
- …day! Apply now! Qualifications: + Bachelor's Degree required with preference in Health Care Administration or comparable field. + Master's Degree preferred. + ... Professional license in Nursing Home Administration required. Responsibilities: + Ensure the development and...commitment to its employees, residents, and larger community. + Review monthly facility operating and budgetary statements + Ensure… more
- University of Rochester (Rochester, NY)
- …patients COBRA entitlement and assist with paperwork if necessary. Compliance + Review Medicare for MSP questions and validations. Investigates and corrects ... Type: Full time Scheduled Weekly Hours: 40 Department: 500183 Health Insurance Counseling Work Shift: UR - Day (United...coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage… more
