- Molina Healthcare (Albany, NY)
- …as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health , pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, ... Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other… more
- Northern Rivers Family Services (Troy, NY)
- …and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/ home visits, medication evaluations, and ... and informal training and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate in quality assurance… more
- Staffing Solutions Organization (Albany, NY)
- …data **Desired Characteristics:** Candidates will have professional experience in public health insurance programs, including New York's Medicaid, Medicare ... Consideration for 100% remote work may be given based on the candidate's home location and alignment with business needs. The incumbent will work with the… more
- University of Rochester (Rochester, NY)
- …regarding waiting time for the provider every 15 minutes. Protects Personal Health Information (PHI) for patients as indicated by HIPAA regulations. Assures ... purposes. Assures completion of all appropriate forms by patients, such as, Medicare Secondary Payer assurance, provision of HIPAA information for new patients,… more
- University of Rochester (Rochester, NY)
- …+ Ensures completion of all appropriate forms by patients, such as Medicare Secondary Payer assurance, provision of HIPAA information for new patients, requesting ... time for the provider every 15 minutes. + It protects patients' personal health information (PHI), as indicated by HIPAA regulations. + Ensures cleanliness and order… more
- University of Rochester (Rochester, NY)
- …purposes. Ensures completion of all appropriate forms by patients, such as Medicare Secondary Payer assurance, provision of HIPAA information for new patients, ... regarding waiting time for the provider every 15 minutes. Protects Personal Health Information (PHI) for patients, as indicated by HIPAA regulations. Ensures… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …email or fax from providers (ie physician offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments across all ... + Adjust claim(s) as warranted based on discussion and review of the provider's issue. + Deliver all information...(CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members… more
- University of Rochester (Rochester, NY)
- …management when needed. + Monitors staff performance and develops methods of performance review and quality control. + Provides specific feedback to staff on a ... cross-training staff. + Assists leadership with payer audits, including quarterly Medicare and Medicaid Credit Balance reports and additional credit balance reports… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: + Review and accurately code radiology procedures using ICD-10, CPT, and HCPCS codes. + Ensure compliance with current healthcare regulations and payer ... guidelines. + Hybrid work available: 1-2 work days from home and 3-4 work days in office Minimum Qualifications:...and anatomy. + Strong understanding of insurance guidelines, including Medicare and Medicaid. + Proficient in EPIC systems for… more