- Humana (Albany, NY)
- …looking for a dedicated and experienced Senior Compliance Professional specializing in Medicare Advantage to join our Field Marketing Organization (FMO). This role ... + Identify solutions to systemic problems identified + Demonstrate an understanding of Medicare regulations and an ability to apply the regulations + Respond to… more
- New York State Civil Service (NY)
- …research on the organization to be audited; * assists in establishing the scope of audit by analyzing and determining areas for audit , and timeframe to be ... examined; * assists in planning audit activities, including specific audit tasks, and...maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on… more
- University of Rochester (Rochester, NY)
- …Physician Self-Referral Law, the False Claims Act, Civil Monetary Penalties, and Medicare and Medicaid billing regulations (including CMS, Medicare Advantage and ... Compliance on relevant reimbursement and billing issues and requirements (including CMS, Medicare Advantage, and New York State Medicaid). Stays abreast of … more
- Intermountain Health (Albany, NY)
- …HIM, PAS, and hospital finance staff as needed. + Prepares monthly Medicare and Medicaid settlement and policy reserve calculations using technically acceptable and ... reimbursement methodologies. + Prepares or reviews cost reports and surveys, reviews audit adjustments and settlements, and files appeals and exception requests to… more
- Highmark Health (Albany, NY)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- CenterWell (Albany, NY)
- …at the division and market level; Partners with Clinical Documentation Improvement, Audit , and Education to develop programs to improve clinical documentation. + ... development and compliance with coding standards. + Partner with analytics and audit to identify coder errors and develop plans to address deficiencies/specific… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …receivable process. This includes the cash/payment reconciliation of the organizations audit groups, overseeing the day-to-day activity of the Accounts Receivable ... and monthly reconciliation; identifying, researching, and resolving variances; and managing audit groups, pursuit of outstanding balances outside of contract grace… more
- Whitney Young Health Center (Albany, NY)
- …statements in an accurate and timely manner for submission to management and Finance/ Audit Committee. Reviews and signs off on all journal entries. Prepares monthly ... analysis of operations for Finance/ Audit Committee and management. Attends Finance Committee meetings and...Coordinates preparation of designated third party cost reports including Medicare , Medicaid and OASAS and assists in the preparation… more
- Bassett Healthcare (Cooperstown, NY)
- …is entered or scanned into the system accurately as monitored by system audit Accurate confirmation of attending PCP and Billing PCP, when appropriate. Assures ... of Advanced Beneficiary Notice signatures and form processing to meet Medicare regulations. Ensures all corrections (demographics, insurance eligibility etc. based… more
- Healthfirst (NY)
- …claims, authorizations, faxes, and any additional information required to complete the audit . + Review and investigate appeals and grievances requests to ensure all ... operational efficiency and production goals. + Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of… more