- CVS Health (Albany, NY)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
- Humana (Albany, NY)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- University of Rochester (Albany, 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
- Humana (Albany, NY)
- …service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical ... of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Rochester, NY)
- …of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Healthfirst (NY)
- …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... review of the website with business owners and ensures compliance with regulatory requirements specific to annual Go to...deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including… more
- Molina Healthcare (Albany, NY)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulatory requirements. **Job ... + Coordinates accountabilities between duals office and shared service to drive compliance and efficiency as well as provide oversight, including service level… more
- Molina Healthcare (Yonkers, NY)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... vendor performance involving onshore and offshore resources, monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality… more
- Humana (Albany, NY)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Syracuse, NY)
- …to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and ... analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At… more