- Humana (Albany, NY)
- …data driven methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care, ... pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and...with staff in different positions and all levels of management positions. + Ability to prioritize, organizes, and executes… more
- Molina Healthcare (Albany, NY)
- …Action Items (SAIs) including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay edits, post payment ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- FlexStaff (Brooklyn, NY)
- …strategies. + Generate performance reports and document all interactions in the data management system . + Work with marketing to create promotional materials and ... of PACE. + Stay updated on relevant regulations and ensure compliance with CMS , DOH, and Medicare /Medicaid guidelines. + Perform additional duties as assigned.… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …addition to Level I Accountabilities): + Qualifies prospects onsite per Centers for Medicare & Medicaid Services ( CMS ) Regulations and closes sale wherever ... organization. + Accountability with strong business, planning, accuracy, and time management skills to self-manage and prioritize while performing multiple tasks and… more
- Elevance Health (Latham, NY)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... test is completed and meets the test plan requirements, system testing is completed, and system is...of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the… more
- Healthfirst (NY)
- …variances to budget. + Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial impacts estimations. + Respond to requests ... + Pull data from the warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) code and generate reports...community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan… more
- Stony Brook University (East Setauket, NY)
- …systems. + Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... Patient Accounting. + Experience in Insurance Verification. + Experience working in Medicare FSS DDE system . **Please Note: Verification of degree (eg,… more
- Catholic Health Services (Rockville Centre, NY)
- …is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home ... cost reports, financial statement entries and other reports as assigned by management . Assigning training and reviewing staff work. Downloads and organizes rate… more
- Stony Brook University (East Setauket, NY)
- …systems. + Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... Qualifications** + Bachelor's degree in Accounting, Business, Health Information Management or related field with a minimum of 6...+ Experience in Insurance Verification. + Experience working in Medicare FSS DDE system . **Special Notes** **:**… more
- Mount Sinai Health System (New York, NY)
- …corrections with PFS, HIM, and clinical stakeholders + Monitor compliance with CMS and third-party payer requirements ** System Administration & Regulatory ... equivalent credential required + Proficient in CPT, HCPCS, revenue codes, and Medicare billing regulations. + Advanced proficiency in Epic, especially in EAP… more