- Mohawk Valley Health System (Utica, NY)
- …variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as a liaison ... with payers to facilitate approvals and prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals. (Peer-to-peer, retrospective/closed record review, concurrent… more
- Bassett Healthcare (Oneonta, NY)
- …Adherence to established Conditions of Coverage for the Center for Medicare & Medicaid services (CMS) for End Stage Renal Disease (ESRD) dialysis clinics. Core ... Social Worker Functions (applies to all Social Workers) Participation in departmental rounds or team meetings as required Comprehensive bio-psychosocial assessment of patient Treatment planning to address issues identified in comprehensive assessment Resource… more
- Elmcrest Children's Center (Syracuse, NY)
- …after-school/evenings if needed. + Documentation: Complete required documentation for Medicaid billing within prescribed timeframes. All case notes and casework ... contacts must documented in OCFS CONNECTIONS database and EMR Netsmart. + Report to Aftercare Coordinator/Clinical Supervisor for regularly scheduled supervision to review cases, youth and family needs and service progress and/or barriers. + Collaborate with… more
- Stony Brook University (Commack, NY)
- …of a managed care organization or payer. + Direct experience with NYS Medicaid and Medicare enrollment and recertification. + Experience setting up and managing the ... Council for Affordable Quality Healthcare (CAQH) profiles. + Knowledge of NCQA, TJC, CMS and New York State Education Department and New York State Department of Health Laws as they pertain to credentialing. + Demonstrate project management skills and be… more
- Mohawk Valley Health System (Utica, NY)
- …givers. + Implement post-discharge plans in accordance with criteria for Medicare, Medicaid coverage, HMO or private insurers. + Collaborate with community agencies ... and service providers to meet transitional care needs. + Perform other duties as required. Education/Experience Requirements REQUIRED: + Bachelor's degree in Nursing or closely related field; or equivalent nursing experience. + 3 years of clinical experience.… more
- Fedcap (New York, NY)
- …through the Marketplace (if offered) and/or into Insurance Affordability Programs ( Medicaid , Child Health Plus, the Essential Plan, and financial assistance for ... QHPs). + Completing new and renewal health insurance applications through the Marketplace website. + Assisting potential enrollees with grievances, complaints or questions regarding their health coverage or a determination related to their coverage. +… more
- Mohawk Valley Health System (Utica, NY)
- …Agency (EPA), National Fire Protection Association (NFPA), Centers for Medicare & Medicaid Services (CMS), and Department of Homeland Security (DHS) regulations and ... standards. Also ensure that the facility meets the Emergency Management criteria required by the hospital accreditation body (eg, DOH, DNV-GL). + Establish mechanisms to collect, review, and track data required by local, state, and federal entities. + Develop… more
- Catholic Health Services (East Hills, NY)
- …Island to receive a five-star rating from the Centers for Medicare & Medicaid Services for consistently high patient satisfaction scores. The Cancer Institute at St. ... Francis Hospital has brought together all the essential elements for an integrated approach to treating patients with cancer, essential to St. Francis Hospital's signature commitment to excellence and compassionate care. Job Details Job Posting: Advanced… more
- Stony Brook University (East Setauket, NY)
- …Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge of third party payer reimbursement ... and managed care contracts. + Experience investigating, reviewing and following-up on rejected/denied inpatient and outpatient hospital claims. + Knowledge of CPT, HCPCs and ICD-10 coding principles. + Experience with Cerner Invision and/or Cerner Millennium… more
- Lifetime Assistance, Inc. (NY)
- …and state regulations including ACCES-VR, OPWDD, DOL, NYSID, NISH and Medicaid Regulations. + Develops and implements Community Prevocational Staff Action Plan ... in accordance with the Life Plan and personal outcome measures at semi-annual and annual review. Makes recommendations regarding transition and employment opportunities. Attends a minimum of two case reviews per year for each person supported. Additional team… more