- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings. Supports and acts as ... is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes...upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Molina Healthcare (Syracuse, NY)
- **(Sales) Compliance Analyst** Molina Healthcare's Medicare Compliance team supports sales operations for the Molina Medicare product lines. It is a ... Operating Procedures and Training documents. . Lead regularly scheduled Sales & Compliance leadership meetings. . Interpret and analyze Medicare , Medicaid, and… more
- Humana (Albany, NY)
- …requirements development. + Creating and executing comprehensive test plans + Ongoing Medicare Pricer maintenance, quality assurance, and compliance + Determine ... community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Northwell Health (Garden City, NY)
- …coding rules and regulations to the validation review process. 6.Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. ... and principals; performs coding audits for optimization. 4.Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained… more
- Ankura (New York, NY)
- …following types of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance , audit, and investigation projects ... degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either within… more
- Highmark Health (Buffalo, NY)
- …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and Medicare Line of Business, ... explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and regulations. The Medicare… more
- CVS Health (Albany, NY)
- …market performance, cost structure and local execution of medical costs management, compliance , and revenue integrity efforts for all Medicare Advantage products ... every day. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, supporting… more
- University of Rochester (Rochester, NY)
- …to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role ... adding newborns onto policy. + Determine the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits. + Notify… more