- Outreach Development Corporation (Richmond Hill, NY)
- … compliance with healthcare regulations, and payer requirements (eg, Medicare , Medicaid, Managed Care Organizations, and Commercial/Private insurers). + Implement ... the senior management team to facilitate informed decision-making. + Ensure compliance with Generally Accepted Accounting Principles (GAAP) or other relevant… more
- Highmark Health (Albany, NY)
- …with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts ... system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare… more
- Molina Healthcare (Rochester, NY)
- …and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Program Director is a key Quality ... and monitors the success of QI activities; and QI Compliance , which provides the strategic direction and implementation of...programs. + 2 years Medicaid experience + 2 years Medicare experience + 3 years management experience + Operational… more
- Molina Healthcare (New York, NY)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations ... satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the… more
- Humana (Albany, NY)
- …+ Ensure platform reliability (>99.9% uptime), security (GDPR/CCPA/TCPA compliance ), and cost efficiency. + Champion modern architecture (microservices, ... resolution, GenAI in marketing). + Drive data privacy, security, and regulatory compliance . **Use your skills to make an impact** Required Qualifications + 10+… more
- Fresenius Medical Center (Hempstead, NY)
- …nurse in accordance with organization policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal ... business policies, procedures and systems incorporated into training, including compliance with ethical business practices + Maintain environmental integrity and… more
- Humana (Albany, NY)
- …on Humana's health plan accreditations, performing complex tasks related to compliance with accreditation standards across multiple operational areas within Humana. ... Experience (ME) and Medicaid Module (MED) requirements, advising stakeholders on compliance . + Works closely with operational areas to prepare documentation and… more
- Humana (New York, NY)
- …insurance operations. This role is responsible for driving process improvements, ensuring compliance , and leading a large team to elevate member and provider ... process improvements to enhance efficiency, member satisfaction, and regulatory compliance . + Oversee resolution of member enrollment issues, claim disputes,… more
- Humana (Albany, NY)
- …tax provisions under ASC 740 and SSAP 101, ensuring accuracy and compliance with US GAAP and statutory accounting principles. + Oversee tax-related disclosures ... appropriate internal controls over tax accounting and reporting, including compliance with SOX 404 requirements. + Collaborate cross-functionally with Finance,… more
- Bassett Healthcare (Milford, NY)
- …we can do for them today as observed by Supervisor and as noted in compliance reports. Takes clear, complete and accurate phone messages, (and follows up on these ... and data entry (such as MSPQ) necessary for regulatory agencies and compliance requirements is accurate and complete as monitored by systems audits. Maintains… more