- Stony Brook University (Commack, NY)
- Managed Care Provider Enrollment Specialist **Position Summary** At Stony Brook Medicine, as a Managed Care Provider Enrollment Specialist, you will work under ... the oversight of the Director of Managed Care Enrollment and join a team of professionals...of roster submission. Inform Director of Enrollment of MCOs non- compliance . A provider enrollment roster should be sent, at… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- **Overview** **Scope of Responsibilities:** Responsible for all regulatory , compliance , and accreditation matters within HealthDirect. Oversees the development, ... + Partners with internal and external legal resources as needed to resolve compliance issues. + Keeps apprised of new regulatory developments by reviewing… more
- Healthfirst (NY)
- … Administration from an accredited institution + Analytical experience in a healthcare environment (such as managed care organization, commercial health ... + Performs first level review of all marketing materials to ensure compliance with State and Federal guidelines. + Prepares and submits marketing materials… more
- City National Bank (New York, NY)
- * REGULATORY ASSOCIATE, IN-BUSINESS CLIENT SERVICE & OPERATIONS RISK & CONTROLS* WHAT IS THE OPPORTUNITY? This position will work directly with the City National ... to support and assist in identifying, monitoring and mitigating operational and regulatory risks within Client Service & Operations.The role will support corporate… more
- Molina Healthcare (New York, NY)
- …network development and management, or project management experience in a managed healthcare setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : ... experience in a managed care setting. * 3+ years experience in managed healthcare administration and/or Provider Services. * Working familiarity with various… more
- Molina Healthcare (Rochester, NY)
- …provider contract, network development and management, or project management experience in a managed healthcare setting. **Required Experience** + 2 - 3 years ... in a managed care setting. + Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare… more
- Highmark Health (Albany, NY)
- …healthcare operations, risk, audit, or legal functions + 5 years in Healthcare Compliance or Privacy **LICENSES or CERTIFICATIONS** **Required** + None ... rules as well as a solid working knowledge of managed care operations, compliance program structures, information...(CIA) + Certified Fraud Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified Compliance… more
- Molina Healthcare (NY)
- …network development and management, or project management experience in a managed healthcare setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : ... in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare… more
- Molina Healthcare (Buffalo, NY)
- …Participate in process improvement initiatives to improve operations + Understands the compliance and regulatory guidelines for each state + Maintains ... coaching, production and appropriate terminations. + Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance . + Responsible… more
- Molina Healthcare (Albany, NY)
- …in resolving complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional ... trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
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