- Highmark Health (Buffalo, NY)
- …improvement models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, ... office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement… more
- Humana (Albany, NY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Humana (Albany, NY)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. +… more
- Humana (Albany, NY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... a part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the Pricer… more
- Molina Healthcare (Syracuse, NY)
- …with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. * Reviews ... quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing,… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and regulations. The ... Responsibilities: + Educate prospects on CPHL MAP product designed for Full Medicaid and Medicare recipients that need in home care and Long-term care services,… more
- CenterWell (Albany, NY)
- …+ Collaborate with market partners and HPS team members to prioritize project requests + Develop project plans, timelines and update cadence for all projects + ... **Become a part of our caring community and help us put health first** The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicare Advantage, and Medicaid requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other… more
- Molina Healthcare (Rochester, NY)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and state regulatory requirements are met ... assisting and executing projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid , and Medicare Advantage requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other… more