- 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, ... analytic development skills and impact the patient community of the Mount Sinai Health System . **Qualifications** + BA or BS degree minimum, in a relevant field of… more
- Northern Rivers Family Services (Albany, NY)
- …entries, and reconciliation tasks assigned by CFO, Controller, Director of Revenue Cycle Management or AR Manager based on workload. You will report to the Chief ... Financial Officer, until the Director of Revenue Cycle Management position is filled and trained, and will work...provide billable services or are required to register with Medicaid/ Medicare based on their credential, department and position. +… more
- Molina Healthcare (Albany, NY)
- …Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. + Provides… more
- Guthrie (NY)
- …care directly to where patients need it most: home. As a 4-star CMS -rated Medicare -certified agency, we deliver skilled nursing, therapy services, social work, ... in the field. Position Summary: Responsible for the case management and provision of quality home nursing services to...and ancillary home health services (direct care and case management ) to ensure that all patient's needs are met… more
- Independent Health (Buffalo, NY)
- …and statistical analyses, specifically designed to support pricing and bidding for Medicare Advantage plans. Such projects will support both internal and external ... insights to enhance pricing and financial performance. + Ensure compliance with CMS regulations and risk adjustment methodologies. + Develop and execute pricing… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and ... monitoring their use and identifying any deficiencies. + Prepare summaries for management of quality review results, including basic analysis of identified trends. +… more
- Catholic Health (Cheektowaga, NY)
- …are current and compliant with applicable federal and state regulation and with CMS and AMA coding guidelines. The Director will be responsible to maintain coding ... auditors and coding vendors. Overall, the director will leverage project management skills, clinical knowledge, coding knowledge and understanding of regulatory… more
- FlexStaff (Bronx, NY)
- …work set forth. + Document all interactions and outcomes in the designated data management /electronic record system . + Work with the marketing team as needed in ... outreach efforts to maximize referral opportunities and targeted goals set forth by management that are subject to change. + Directly assist intake and provider… more
- Healthfirst (NY)
- …with internal teams (eg, sales, customer service, compliance) to ensure seamless management of members. + Monitor ,report, and deliver updates on memberships, data ... Billing activities are managed in compliance with State and CMS guidelines and to ensure member satisfaction + Lead...Working knowledge of how data processes through systems and system integrations work to understand and plan for addressing… more
- Molina Healthcare (NY)
- …inquiries. + Performs Plan Required Reporting. + Interpret and analyzes Medicare , Medicaid and MMP Required Reporting Technical Specifications. + Create and ... quarterly Key Performance Indicator (KPI) reports. + Support the management of the regulatory memo distribution process Ability to...notices of proposed rulemaking. + Manages user access to CMS . + Analyze data use critical thinking + Ability… more