- Centene Corporation (New York, NY)
- …changes everything for our 28 million members. **Position Purpose:** Ensure regulatory compliance with state and other government agencies related to the health ... subsidiaries. + Ensure business unit and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory… more
- YAI (Manhattan, NY)
- …including, but not limited to State regulatory agencies (OPWDD, Centers for Medicare and Medicaid Services (CMS), Office of Medicaid Inspector General (OMIG), ... annual OPWDD DQI and OFPC surveys. + Supports regional leadership with identifying compliance risks, completing an annual risk assessment, and developing an annual … more
- Humana (Albany, NY)
- …community and help us put health first** The Associate Actuary, Risk and Compliance is responsible for the overall management and oversight of activities concerned ... and cost-effective approaches to minimize risks. The Associate Actuary, Risk and Compliance work assignments involve moderately complex to complex issues where the… more
- Staffing Solutions Organization (Albany, NY)
- …NY** **Division of Eligibility & Marketplace Integration (DEMI)** **Bureau of Program Compliance and Audit** **50% Onsite 50% Remote** **Duties:** The Bureau of ... Program Compliance and Audit is seeking a highly motivated individual...professional experience in public health insurance programs, including Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also… more
- Humana (Albany, NY)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director's work… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …need for healthy living. JOB SUMMARY : The Licensed Benefits Advisor- Medicare Sales, Maintains relationships, services our existing customers and secures new ... explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and regulations. The Licensed… more
- Humana (Albany, NY)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs… more
- Molina Healthcare (Buffalo, NY)
- …experience on researching, presenting and documenting is required, + Experience with Medicare , Medicaid and Marketplace is required. + Medical coding experience is ... highly preferred. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 7-9 years **Preferred Education** Graduate Degree or equivalent experience **Preferred Experience**… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** Provides leadership to the Medicare Duals team and plays a critical role in advancing the Medicare Integrated Duals segment ... strategic priorities. Develops and executes Medicare strategies, including state-specific and product-specific growth initiatives. Leads high-priority projects… more
- Humana (Albany, NY)
- …submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to enhance the ... encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission... + Ensure encounter submissions meet or exceed all compliance standards via analysis of data + Develop tools… more