- Excellus BlueCross BlueShield (Rochester, NY)
- …read assignments. May support vendor discussions and feedback related to quality audit findings. Presents results and learning opportunities to the team. * Serves ... and audits utilizing knowledge and experience of ICD-9-CM/ICD-10-CM coding, Medicare Advantage and Commercial Hierarchical Condition Category (HCC) coding, and… more
- Centene Corporation (New York, NY)
- …disenrollment compliant audits, providing examples of any gaps that could change our Medicare STAR rating by H-contract. Able to interpret and understand changes to ... performing CMS Plan Finder "member choosing to leave plan" Star measure audit . Oversee training and mentoring other Business Analysts. Experience managing projects… more
- YAI (Manhattan, NY)
- …agencies (Office for People with Developmental Disabilities (OPWDD), Centers for Medicare and Medicaid Services (CMS), Office of Medicaid Inspector General (OMIG), ... + Attends regional and/or departmental meetings to keep staff informed about audit findings and risks, new developments in compliance regulations and compliance… more
- New York State Civil Service (Mohegan Lake, 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
- University of Rochester (Rochester, NY)
- …drugs (HazD) in compliance with USP 800 standards, Centers for Medicare and Medicaid Services┐ Conditions of Participation, Department of Health regulations, ... maintained in a current state, and all sites remain in a ready for audit /inspection state. Serves as the chair for the Hazardous Drug Steering Committee. JOB DUTIES… more
- Charles Evans Center (Bethpage, NY)
- …front desk supervisor on billing issues + Monitor provider credentialing with Medicaid, Medicare , and commercial plans + Assist with review and negotiation of payer ... CFO review + Oversee adjustments, write-offs, and collection efforts as needed + Audit ECW mapping to ensure complete and accurate data capture Qualifications: +… more
- New York State Civil Service (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 ... and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining eligibility.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Manager + To provide support and training for representatives once identified during the audit in the field + To collaboratively work with managers to ensure each ... paced environment + Managed long term care knowledge + Medicaid knowledge + Medicare knowledge SCOPE INFORMATION # Direct Reports: Training and Development Manager -… more
- Mohawk Valley Health System (Utica, NY)
- …payor review in collaboration with attending physicians. + Support Recovery Audit Contractors (RAC's). + Assist with mitigating barriers to discharge and ... clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as… more
- Elderwood (Lake Placid, NY)
- …for Full-time and Part-time positions Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement ... mix systems + Conduct resident interviews + Compile, monitor, and audit clinical documentation + Communicate clinical issues effectively to appropriate clinicians… more