- Molina Healthcare (NY)
- …of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid , and Marketplace government -sponsored programs . * Data ... claims projects. * Evaluates claims using standard principles and applicable state -specific regulations to identify claims processing errors. * Applies claims… more
- Evolent (Albany, NY)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Evolent (Albany, NY)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Humana (Albany, NY)
- …contract requires US Citizenship + Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services) + HGB ... authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates...care service experience or working knowledge of TRICARE ACD program . + Healthcare professional with a Bachelor's degree in… more
- Highmark Health (Albany, NY)
- …deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act ... medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation… more
- Evolent (Albany, NY)
- …future of oncology care delivery** . + Not under sanction or exclusion from Medicare/ Medicaid programs . To ensure a secure hiring process we have implemented ... within the past 2 years. + Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain). + Demonstrated **leadership in… more
- Humana (Albany, NY)
- …stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and ... banking, corporate/business unit strategy, or finance + 2+ years of project/ program leadership experience + Demonstrated ability for bringing structure to ambiguity… more
- Humana (Albany, NY)
- …onboard** providers to establish new EMR connections within the Payment Integrity program . + **Monitor and analyze performance metrics** to ensure data quality, ... Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will...Language Rating (ILR) test as provided by the Federal Government . Travel: While this is a remote position, occasional… more
- Humana (Albany, NY)
- …stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and ... Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will...Language Rating (ILR) test as provided by the Federal Government . Travel: While this is a remote position, occasional… more