- Mount Sinai Health System (New York, NY)
- …equivalent credential required + Proficient in CPT, HCPCS, revenue codes, and Medicare billing regulations. + Advanced proficiency in Epic, especially in EAP ... with the performing departments **Charge Capture Auditing & Compliance:** + Audit charge capture for inpatient, outpatient, clinic, ED, and ambulatory services… more
- Molina Healthcare (Albany, NY)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more
- Elderwood (Hornell, NY)
- …in the Nursing department. + The ADON (RN) shall assess residents, perform audit measures and follow state, local and federal regulations and best practices within ... + Supervise all admissions and readmissions for eligibility or denial of Medicare Skilled services regulations. + Notify all providers, in writing, within 24… more
- Molina Healthcare (Rochester, NY)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- Outreach Development Corporation (Richmond Hill, NY)
- …investments to optimize returns and align with the organization's values. Audit and Internal Controls + Collaborate with external auditors to facilitate ... the annual audit process and address any audit findings....in compliance with healthcare regulations, and payer requirements (eg, Medicare , Medicaid, Managed Care Organizations, and Commercial/Private insurers). +… more
- New York State Civil Service (Staten Island, NY)
- …and statistical reports on facility activities and patient progress for program audit and evaluation, third party reimbursement, and program reporting units.* Review ... maintain eligibility for full and unconditional participation in the Medicaid/ Medicare programs. Failure to maintain licensure, certification and Medicaid/… more
- TEKsystems (Rochester, NY)
- …calls related to insurance claims, benefits, and pre-authorizations, with a focus on Medicare and Commercial lines of business. You will act as a liaison between ... and professional service. Key Responsibilities: + Respond to Department of Health audit calls and provider inquiries with professionalism and accuracy. + Handle… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...International Classification of Disease (ICD) codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- Healthfirst (NY)
- …monthly analysis for analytical meetings discussing variances to budget. + Manage all analytical audit requests as they relate to Medicare RADV and OIG and ... occurring in our provider community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan and owner hospital performance.… more
- New York State Civil Service (Queens Village, NY)
- …issues regarding diagnostic codes for laboratory agencies and Medicaid and Medicare reimbursements.* Prepares for, coordinates, and participates in regulatory agency ... Bureau Liaison and lead contact for the Consolidated Fiscal Review (CFR) Audit . * Function as BFDDSO's lead for various databases, including maintaining databases… more