- Rochester Regional Health (Rochester, NY)
- …of departmental office supplies within budget. + Performs all functions of medical secretary when necessary. Assumes leadership role in the practice manager absence. ... cash fund and change fund. + Maintains up-to-date knowledge of, and ensure compliance with, all internal and external regulator and third party payor requirements,… more
- Guthrie (Cortland, NY)
- …of health benefit plans and related UM requirements preferred. Experience with CPT/ICD coding , medical record or chart auditing, and experience in utilization ... notification according to payer requirements. + Assists to ensure compliance with documentation requirements and guidelines of third-party payers, regulatory… more
- WMCHealth (Valhalla, NY)
- …occurrences. The Performance Improvement Coordinator collaborates with the Trauma Medical Director, Trauma Program Manager, Trauma Registrars and other disciplines ... Improvement (PI) Program for the hospital in collaboration with the Trauma Medical Director and Trauma Program Manager Assist the Trauma Program Medical… more
- Trinity Health (Troy, NY)
- …& ensures that patients meet financial requirements including Medicare medical necessity, payer pre-certifications & referrals. Provides general information to ... & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as...(1) year of hire. **Additional Qualifications (nice to have)** Medical terminology required & knowledge of diagnostic & procedural… more
- CVS Health (Albany, NY)
- …data to provide insights into configuration management metrics, trends, and compliance issues. + Applies in-depth knowledge of configuration management tools and ... ClaimsXten, Cotiviti PPM & CV) + Extensive knowledge of CPT, HCPCS, ICD-10 coding **Preferred Qualifications** + Prior Relevant Work Experience 3-5 years + Working… more
- Molina Healthcare (Buffalo, NY)
- …schedule) Looking for a RN with experience with appeals, claims review, and medical coding . JOB DESCRIPTION Job SummaryProvides support for clinical member ... Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes clinical… more
- Callen-Lorde Community Health Center (New York, NY)
- …or related field preferred. + CPC, CCS, or CBCS certification. + 5+ years' medical billing and coding experience, + 4+ years of supervisory experience. + ... This role manages a growing team, develops and refines operational practices, ensures compliance with all applicable laws and regulations, and serves as a key… more
- Molina Healthcare (Rochester, NY)
- …coverage audit policies and be able to apply them in ensuring program compliance via payment integrity programs. The position must have the ability to determine ... correct coding , documentation, potential fraud, abuse, and over utilization by...providers and recipients. The position will review claims data, medical records, and billing data from all types of… more
- CVS Health (Albany, NY)
- …governance policies related to Salesforce development and deployment** + **Ensures compliance with security standards and best practices** + **Works closely with ... technical leadership and guidance to development teams, ensuring best practices, coding standards, and overall quality of deliverables** + **Mentors administrators… more
- MetLife (Oriskany, NY)
- …to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance * Accountable for Reviews and approves key decisions made by team ... member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates… more