- Molina Healthcare (Buffalo, NY)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Buffalo, NY)
- …Act** cases in accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Rochester, NY)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid/ Medicare /Marketplace health coverage audit policies and be able to apply them in ... data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure investigators are managing their cases… more
- Elderwood (Williamsville, NY)
- …+ Supervise all admissions and readmissions for eligibility or denial of Medicare Skilled services regulations. + Notify all providers, in writing, within 24 ... + Ensure that written physician certification for skilled services per Medicare guidelines are obtained. + Coordinate therapeutic services, Physical Therapy,… more
- SUNY Upstate Medical University (Syracuse, NY)
- …of certification must be consistent with practice). Must have NPI number and be Medicare Enrolled with Medicare Identification Number (or PTAN) OR be eligible ... for Medicare Enrollment within 6 months of hire (eligibility criteria for NP requires National Certification through AANP or ANCC, and Master's Degree) (eligibility… more
- Humana (Albany, NY)
- …of the responsibilities: + Engage with the producers and the Center for Medicare and Medicaid Services/Department of Insurance regulations specific to them if there ... proper entries to the general ledger. + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required… more
- Humana (Albany, NY)
- …+ 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. + ... role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Albany, NY)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- SUNY Upstate Medical University (Syracuse, NY)
- …of certification must be consistent with practice). Must have NPI number and be Medicare Enrolled with Medicare Identification Number (or PTAN) OR be eligible ... for Medicare Enrollment within 6 months of hire (eligibility criteria for NP requires National Certification through AANP or ANCC, and Master's Degree) (eligibility… more
- Humana (Albany, NY)
- …expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims ... technical skills, especially SQL, VBA, and Databricks/Python + Individual Medicare Advantage experience + Knowledgeable on ESRD population **Additional Information**… more