- Elderwood (Hamburg, NY)
- …assesses information for the health and well-being of residents in Medicare - or Medicaid-certified nursing homes. Following federally-mandated procedures and using ... Most MDS nurses work in nursing homes, but some are employed in other Medicare - or Medicaid-certified facilities. + The MDS Nurse supports the MDS/PPS Coordinator in… 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
- Evolent (Albany, NY)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Northwell Health (Lake Success, NY)
- …of care provided. Responsible for concurrent inpatient medical record reviews for Medicare , Medicaid and all commercial payers. Generates queries and have follow up ... for file maintenance including entry into database for tracking and trending audit results. Communicate findings of potential or missed diagnoses and the revenue… 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
- Bassett Healthcare (Milford, 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
- Humana (Albany, NY)
- …+ Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure + ... Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and… more
- HCR Home Care (Rochester, NY)
- …procedures and follow the Employee Handbook Guidelines . + Quality: + Audit clinical records to identify trends/areas of improvement in processes and documentation. ... + Clinical assistance : + Triage incoming calls. + Audit /Review DRRs . + Other duties as assigned. This...- solve effectively. + Possess es knowledge of the Medicare /Medicaid guidelines governing home health agencies. + Organized, detail-oriented… more
- City of New York (New York, NY)
- …Program, Management Benefits Fund, Employee Assistance Program, Work Well NYC, Medicare Part B Reimbursement and Pre-Tax Benefits & Citywide Programs including ... rules, laws and policies and oversight of the agency's pre audit hiring and post audit promotions/salary adjustments plans. - Implement personnel actions for new… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …policies and procedures or any other regulatory requirements. + Follow defined audit processes and keep up to date with departmental changes in conducting ... quality review results, including basic analysis of identified trends. + Analyzes audit results to recommend system or procedural changes to increase claim accuracy… more