- Molina Healthcare (Rochester, NY)
- …**Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will ... protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by… more
- Molina Healthcare (Syracuse, NY)
- …**Job Summary** Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in ... development of MHI's business process improvement methodology and in the implementation of a business process improvement capability. **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for most complex process analysis, design, and simulation. + Requires highest… more
- CVS Health (Albany, NY)
- …**Work Schedule: Start times between 7:50 am and 11:45 am EST** The Worklife Resource Consultant is part of the Worklife Team and provides education about community ... resources, resource needs assessment, and community and/or national referrals to a variety of customers for a variety of needs including childcare, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation and… more
- Humana (Albany, NY)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director's work… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …need for healthy living. JOB SUMMARY : The Licensed Benefits Advisor- Medicare Sales, Maintains relationships, services our existing customers and secures new ... in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and...to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5)… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** Provides leadership to the Medicare Duals team and plays a critical role in advancing the Medicare Integrated Duals segment ... strategic priorities. Develops and executes Medicare strategies, including state-specific and product-specific growth initiatives. Leads high-priority projects… more
- Humana (Albany, NY)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Understands… more
- CVS Health (Albany, NY)
- …Tracking Module (CTM) Senior Coordinator, you will be part of the Medicare Complaints Tracking Module (CTM) Team, responsible for researching and resolving ... complaints received via the Centers for Medicaid and Medicare Services (CMS). In this role, you will manage...In this role, you will manage a queue of Medicare complaints. These complaints can include various issues ranging… more
- New York State Civil Service (New York, NY)
- …individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). ... appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a...to allow for your services to be billed through Medicare and Medicaid. If you are appointed and lose… more
- Humana (Albany, NY)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...HR. DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and… more