- Humana (Albany, NY)
- …about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and ... validate the mitigation of compliance risk across the organization. This team ensures that...revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and… more
- YAI (Manhattan, NY)
- …Key/Essential Functions & Responsibilities + Implements the organization's compliance program under the supervision of the Assistant Director ... of Corporate Compliance and in coordination with program staff. + Maintains...(Office for People with Developmental Disabilities (OPWDD), Centers for Medicare and Medicaid Services (CMS), Office of Medicaid Inspector… 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
- Centers Plan for Healthy Living (Staten Island, NY)
- …they need for healthy living. JOB SUMMARY: The objective is to ensure ongoing compliance , provide support and training by monitoring the field staff on a monthly ... basis. The Trainer/ Auditor will provide oversight of the field staff. He/she...to utilize in developing strategy and plans that ensure compliance and can also be used to keep class… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards...changes necessary to provide the most valid documentation in compliance with Federal and State regulations. + Reports to… 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
- 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
- Highmark Health (Albany, NY)
- …This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within ... responsible for the administration, interpretation, and enforcement of the Compliance Program including auditing/monitoring operational processes, conducting or overseeing… more