- 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
- Catholic Health Services (Rockville Centre, NY)
- …care analysis, home office cost reports, budget capital reports, and various Medicare / Medicare cost report schedules, working alongside Director and Staff. ... monthly reports and payments to the HCRA pools. Coordinates audit response to Third Party Auditors, NGS, CMS, or...ICR and Bad Debts and Charity Care audits. Coordinates audit response to NYS Auditors in relation to DSH/ICR… more
- Elderwood (North Creek, NY)
- …to provide this service. + Notifies resident and/or responsible party of Medicare and Insurance coverage or non-coverage for resident. + Verifies insurance coverage; ... in response to requests from third party payers and Medicare for additional information and ensures responses are timely...month end process. + Prepares year-end documents for financial audit . + Direct Supervision and oversight of Business Office… more
- UHS (Binghamton, NY)
- …and documentation compliance in accordance with all coding guidelines and Medicare /Medicaid regulations. Assist with coding, documentation, and billing questions to ... ensure compliant coding and billing. Develop final audit reports based on findings/observations during the ... audit reports based on findings/observations during the audit process to present to providers or other appropriate… more
- Humana (Albany, NY)
- …to determine issues and improvements + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required ... + Research and analyze compliance information necessary to support internal and external audit activity. + Act as "Go To" person for resolution of issues relating… more
- Project Renewal, Inc. (New York, NY)
- …with federal, state, and local healthcare regulations (eg, HIPAA, Stark Law, Medicaid/ Medicare , Part 2). + Ensure the organization's compliance program meets FQHC ... Article 28 clinics, and substance use disorder-focused programs. + Coordinate audit responses, inspections, and compliance reporting for regulatory bodies (such as… more
- New York State Civil Service (East Syracuse, NY)
- …and contemporaneously in accordance with clinic policies and procedure and Medicare , Medicaid, and other regulations and standards of practice.* Perform Periodic ... for everyone in your caseload, completes: review of medical section ISP, medication audit (each home). * Keeps up to date regarding changes to medical section… more
- Option Care Health (Albany, NY)
- …expert in health care compliance including, but not limited to FWA, Medicare & Medicaid billing requirements, and interactions with healthcare professionals. Lead or ... teams. Collaborate across all functions including Operations, Market Access, Internal Audit , Legal, Clinical & Quality, Human Resources and Finance and others… more
- Healthfirst (NY)
- …updates to payment methodologies, fee schedules and claims editing policies from Medicare , Medicaid, and third-party sources. + Responsible for the overall success ... before sign-off and Production. + Assist in the on-going audit of configurations for new and existing claims business...MHS and/or MACESS systems a plus. + Knowledge of Medicare and Medicaid programs and reimbursement methodologies a plus.… more
- Healthfirst (NY)
- …York State regulations, job aides and HF policies. This includes review of performance audit reports in order to maintain superior and accurate care data for each ... programs such as MAP or MLTC + Knowledge of Medicare Regulations related to Long Term Care + Experience...care plan + Understanding of health plans such as Medicare , Medicaid and/or Managed Long-Term Care Plan (MLTCP) +… more