- Humana (Albany, NY)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Albany, NY)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years....the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… 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 . Looking for long-term improvements of encounter submission processes....the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- WMCHealth (Warwick, NY)
- …loss, destruction or unauthorized use. + Audit departments to ensure compliance with state, federal and organizational regulations/requirements. + Reviews medical ... other providers, regulatory agencies, billing agencies, and auditing agencies including Medicare , Medicaid, and third-party billers. + Scans, uploads, and files… more
- Molina Healthcare (Rochester, NY)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Molina Healthcare (Buffalo, NY)
- …Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations ... and guidelines of risk adjustment data * Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy * Identify opportunities for data mining to ensure data gaps are minimized * Apply… more
- Wolters Kluwer (New York, NY)
- …information and policy data sources (CMS, FDA, etc.) covering drug control/ compliance programs, covered programs ( Medicare /Medicaid) and other government ... drug-related policy and program information. * Have an in-depth understanding of drug classification systems, drug packaging attributes, drug clinical attributes, pricing and reimbursement data, and regulatory classifications-and how these data types are used… more
- Humana (Albany, NY)
- …the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Required Qualifications** + MD or DO degree + 5+… more
- New York State Civil Service (Brooklyn, NY)
- …and scheduling to ensure quality care* Ensuring nursing operations are in compliance with laws, regulations, and standards of care* Preparing for regulatory visits ... that aligns with KPC and OMH mission * Implementing compliance and regulatory process structures to meet Joint Commission...on any of the Federal and/or State Medicaid and Medicare exclusion lists. If appointed and subsequently listed as… more
- New York State Civil Service (Binghamton, NY)
- …Supervisor 1 Psychiatric and other nursing and direct care staff* Ensuring compliance with established standards of nursing care in accordance with State, federal, ... on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal...appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a… more