- Mohawk Valley Health System (Utica, NY)
- …Environmental Protection Agency (EPA), National Fire Protection Association (NFPA), Centers for Medicare & Medicaid Services ( CMS ), and Department of Homeland ... for disasters identified in the HVA/risk analysis. + Collaborate with the management team in the creation, development, education, training, and implementation of… more
- Rochester Regional Health (Rochester, NY)
- …and reporting tools highly desired. + May need previously experience in CMS , Medicaid/ Medicare billing, and other regulatory processes. EDUCATION: LICENSES / ... Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily review process… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and audits utilizing knowledge and experience of ICD-9-CM/ICD-10-CM coding, Medicare Advantage and Commercial Hierarchical Condition Category (HCC) coding, and ... * Meets or exceeds productivity targets as established by management . Regularly meets due dates as assigned. * Ensures...ICD-9-CM, ICD-10, CPT, HCPC) * Familiarity and understanding of CMS HCC Risk Adjustment coding, Medicaid CRG coding, and… more
- Healthfirst (NY)
- …+ Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of Centers for Medicare & Medicaid Services ( CMS ) or New York State + Department of ... The Case Manager, Utilization Management coordinates the care plan for assigned members...and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management… more
- Mohawk Valley Health System (Utica, NY)
- PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The Physician Advisor collaborates with Care Managers and Attending Physicians to align on the level of ... Monitor observation and the application of the 2nd Midnight across payor types ( CMS regulation). + Perform concurrent review and escalation of cases not meeting… more
- Mount Sinai Health System (New York, NY)
- …as IDX, Soarian, etc. + Knowledge of the New York State Medicaid and CMS Medicare regulations and related reporting requirements, such as STARS,QARR, MMCOR, ... impact the patient community of the Mount Sinai Health System . Serves as mentor to others in the Data...analytics related to revenue modeling, managed care contracting, population management , case management , clinical or financial decision… more
- Molina Healthcare (NY)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Molina Healthcare (Buffalo, NY)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Stony Brook University (East Setauket, NY)
- …role. + Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge ... and business systems configuration, including: Patient Billing, Claims Scrubber, Contract Management and Work Listing Software. + Interpret billing, coding and… more
- CenterWell (Hauppauge, NY)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more