- Cognizant (Albany, NY)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and focused under multiple pressures and demands. * Ability to complete required internal Medicare Training per Center for Medicare Services within one year of ... start date. * PC skills essential: spreadsheet and word processing applications, database functions and sales force automation software applications. Level II (in addition to Level I Qualifications) * Two or more years of experience in a sales operation's… more
- New York State Civil Service (Utica, NY)
- …eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain licensure, certification and Medicaid/ Medicare ... eligibility will result in the termination of employment. Mandatory overtime (MOT) is a requirement of this position. Chosen candidate(s) will be added to the mandatory overtime roster, which is utilized on a rotating basis. The MOT is applied during times of… more
- Humana (Albany, NY)
- …+ Accounting/Finance knowledge/experience + Advanced SQL or similar + Medicare /Medicaid experience + Data architecture/solution architecture experience + Project ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Albany, NY)
- …reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information** ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Mobile Health (Port Washington, NY)
- …strategy with the complexities of healthcare reimbursement across commercial, Medicaid, Medicare , and self-pay populations. Team Leadership & Development: + Lead, ... strategy with the complexities of healthcare reimbursement across commercial, Medicaid, Medicare , and self-pay population preferred + Proven track record of driving… more
- Kestra Medical Technologies, Inc (Buffalo, NY)
- …regulated by the Federal Food and Drug Administration and under contract with Medicare ; Kestra maintains a drug free environment and testing is a condition of ... products regulated by the Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing is a condition of… more
- WellLife Network (NY)
- …timely, and accurate claims to private and public insurance payers, including Medicare , Medicaid, and commercial plans. 2. Verify the accuracy and appropriateness of ... process. + Strong understanding of CPT, ICD-10, and HCPCS coding principles. + Knowledge of, HMO/PPO, Medicare , Medicaid, and other payer requirements and systems. more
- Sedgwick (Albany, NY)
- …limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests ... principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral… more
- Molina Healthcare (Buffalo, NY)
- …performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** **Required ... - 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Experience with Databricks + Proficiency… more