- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... Preferred Qualifications + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid, or other Medical management organizations,… more
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare… more
- Humana (Albany, NY)
- …Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement ... of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development of the annual Medicare … more
- Humana (Albany, NY)
- …Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and Medicare Advantage value based programs. DVACO is a joint venture among ... areas including HR. DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and approximately 70,000 … more
- Humana (Albany, NY)
- …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails...help people with Medicare , or both Medicare and Medicaid, achieve… more
- Humana (Albany, NY)
- …Growth team's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development and large-scale strategy program management. ... and technology domains + Serve as the principal architect for large-scale Medicare Advantage strategy initiatives, guiding the end-to-end lifecycle from strategy… more
- Humana (Albany, NY)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance. +… more
- University of Rochester (Albany, NY)
- …on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role involves in-depth communication, collaboration, and ... adding newborns onto policy. + Determine the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits. + Notify… more
- WMCHealth (Warwick, NY)
- …authorizations. + Obtain Pre-Admission Authorizations and continued stay authorizations with Medicare , Medicare Advantage , Medicaid, and Insurance Programs. ... providers, regulatory agencies, billing agencies, and auditing agencies including Medicare , Medicaid, and third-party billers. + Scans, uploads, and...+ Maintain access to Medicare common working files and calculate Medicare … more
- Humana (Albany, NY)
- …+ Experience working in coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills developing reports and ... Information** + This role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside of bid season + The… more