- 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
- New York State Civil Service (Brooklyn, NY)
- …in orientation and mentoring of new RNs and LPNs.*Complete evaluations.*Monitor/Complete nursing audit for the cluster, work closely with the Nursing Supervisor / ... complete: a review of the medical section Life Plan/CFA, medication audit (each home/day program).*Participates in Nurse on call rotation.*Obtain individual's… more
- Mount Sinai Health System (New York, NY)
- …is an affordability crisis as federal and state governments are unable to keep Medicare & Medicaid solvent, employers are stretched to pay for health benefits for ... IACUC and RITN) and reviews IRB and IACUC protocols. 13. Oversees the audit of Nuclear Medicine/Nuclear Cardiology/ PE.T suite areas. 14. Oversees the development of… more
- New York State Civil Service (Albany, NY)
- …additional support to the MCRE unit on Medicaid-related issues, including Medicaid audit and wage and hour issues. Provide general legal support to Counsel's ... individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program).… more
- New York State Civil Service (Albany, NY)
- …Provide additional support to the MCRE unit on Medicaid-related issues, including Medicaid audit and wage and hour issues. Provide general legal support to Counsel's ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining… more
- Cardinal Health (Albany, NY)
- …for every interaction using the appropriate database for the inquiry + Must self- audit intake activities to ensure accuracy and efficiency for the program + Make ... prior authorizations, and appeals, preferred (2+ years) + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies, preferred… more
- Highmark Health (Albany, NY)
- …will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert Investigators of the need ... fraud waste and abuse cases; Prepare reports and other information to document audit findings. + Calculate over-payments in established fraud, waste and abuse cases.… more
- Project Renewal, Inc. (Brooklyn, NY)
- …Update weekly caseload breakdowns and assign new clients to Case Managers. + Audit client charts weekly to ensure adherence to regulatory standards of service ... services. + Advises clients of entitlement possibilities and refers them for Medicaid/ Medicare , Public Assistance, & Food Stamps as needed. + Ensures that all… more
- Humana (Fort Drum, NY)
- …internal and external stakeholders. + Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- New York State Civil Service (Goshen, NY)
- …for everyone in your caseload, completes review of medical section ISP, medication audit (each home)* Keeps up to date regarding changes to medical section on ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining… more