- Elevance Health (East Syracuse, NY)
- … Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement Senior** will support our Medicare Administrative Contract ... + Requires a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and experience which would… more
- Elevance Health (East Syracuse, NY)
- …Requirements:** + Requires a BA/BS degree and a minimum of 5 years of audit /reimbursement or related Medicare experience; or any combination of education and ... ** Audit & Reimbursement III** **Location** : This role...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare… more
- WelbeHealth (Albany, NY)
- …growth drivers + Assist with month-end close, quarterly financial reporting, financial audit , Medicare /Medicaid audits, and other PACE specific projects + Keep ... payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D) along with PACE rates and regulatory constructs **Job… more
- Humana (Albany, NY)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... participate in meetings involving care management, provider relations, quality of care, audit , grievance and appeal and policy review. The Behavioral Health Medical… more
- Molina Healthcare (Yonkers, NY)
- …from regulatory agency through analysis and response to findings. * Organize audit submissions, interact directly with auditors for all lines of business as ... of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates… more
- Molina Healthcare (Albany, NY)
- …durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (NY)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts. **Knowledge/Skills/Abilities** + Assist with the identification and… more
- Healthfirst (Enfield, NY)
- …implementation throughout the year. + Assist with corporate initiatives related to Medicare quality or STAR ratings- ie HRAs/FPL/MSP. + Successfully pass audit ... (educational and marketing) exams. + Additional duties as assigned. **Work Location** **The Outside Sales Rep will work at locations they develop within their designated territory, or they may need to visit prospects homes.** **Minimum Qualifications &… more
- Staffing Solutions Organization (Albany, NY)
- …of Eligibility & Marketplace Integration (DEMI)** **Bureau of Program Compliance and Audit ** **50% Onsite 50% Remote** **Duties:** The Bureau of Program Compliance ... and Audit is seeking a highly motivated individual to ensure...professional experience in public health insurance programs, including Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also… more
- Humana (Albany, NY)
- …expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical ... of all relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. + Applies clinical… more