- Healthfirst (NY)
- …of at least two or more lines of business such as Medicare NY/NJ, Medicaid , Family Health Plus, Child Health Plus, NH Family + Experience managing a Quality ... Assurance or Operations Audit team. + Experience working with AI or other machine learning tools to assist with streamlining QA processes. + Experience working with delegates/vendors in a healthcare insurance setting. + Demonstrated experience or deep… more
- University of Rochester (Rochester, NY)
- …to integrate operations with other components of URMC, such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, ... Utilization Management, Social Work, Patient Accounts, Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. + Works closely with Transfer Center and Transplant teams to review after hours requests for insurance review… more
- Healthfirst (NY)
- …of the changes occurring in our provider community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan and owner hospital ... performance. **Minimum Requirements:** + Bachelors degree from an accredited institution. + At least 5 years previous work experience within risk adjustment + Credentialed Associate of the Society of Actuaries (ASA) + Proficiency in SQL (Script Development,… more
- Healthfirst (NY)
- …like Tableau and Knowledge of NY lines of business such as Medicare NY, Medicaid , Child Health Plus, QHP, EP, HARP + Bachelor's degree in Accounting, Finance, or ... Business Administration from an accredited institution preferred. + Certification in claims processing or related area (eg, CPC, AIC) WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard… more
- City of New York (New York, NY)
- …The Medical Assistance Program (MAP) administers public health insurance programs, including Medicaid , for the City of New York. Applying individuals and families ... other health care services at little or no cost. Medicaid Eligibility Operations is recruiting for one (1) Principal...Section Supervisor, under the general direction of the Section Manager , with wide latitude for the exercise of independent… more
- City of New York (New York, NY)
- …The Office of Constituent Services /Ombudsman Case Reviewer within the Medicaid Eligibility Information Services (EIS) is responsible for interviewing Medicaid ... applicants and reviewing their documentation to determine eligibility for Medicaid . The Office of Constituent Services /Ombudsman is seeking two (2) Eligibility… more
- Molina Healthcare (Syracuse, NY)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Molina Healthcare (Syracuse, NY)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in… more
- Community Missions of the Niagara Frontier (Niagara Falls, NY)
- …the pre-employment process, Relias training system, and Agency Survey process. Audit Medicaid service requirements documentation. Assist QA Manager in overall ... functioning of the Quality Assurance Department. Qualifications: Associates Degree in Human Service related field. Good organizational and time management skills. Ability to communicate both verbally and in writing in a clear and concise manner. Must have… more
- University of Rochester (Rochester, NY)
- …on assigned tasks, following standard procedures, and as directed by the Manager , Billing or Manager . Independent judgement is necessary in escalating ... of credits - - Review and advise supervisor or manager on trends of incorrectly paid claims from specific...- 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over $10,000 report… more