- Humana (Albany, NY)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Highmark Health (Buffalo, NY)
- …interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to ... of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is...is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue… more
- Molina Healthcare (NY)
- …their financial and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB ... and manage information from large data sources. + Analyze claims and other data sources to identify early signs...- 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare… more
- New York State Civil Service (Albany, NY)
- …May serve as subject matter expert (SME) for the following subject/program areas: Medicaid , SSI, Social Security, Medicare , Food Stamps, Outside Hospital Care ... NY HELP Yes Agency Mental Health, Office of Title Resources & Reimbursement Agent 1/Trainee 1&2 (NYS HELPS), Central Office; Occupational Category Financial,… more
- Danaher Corporation (New York, NY)
- …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more
- Humana (Albany, NY)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Molina Healthcare (NY)
- …and troubleshooting. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, ... or reimbursement processes + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg, performing basic… more
- Catholic Health Services (Smithtown, NY)
- …Compliance: Stay up-to-date on current reimbursement regulations and guidelines (eg, Medicare , Medicaid ) and ensure compliance. + Data Analysis: Analyze ... and patient, every time. Job Details Summary: The Clinical Reimbursement and Quality Management plays a vital role in...reimbursement . + Claim Review: Review and analyze submitted claims for accuracy and identify potential areas for improvement… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …BlueShield Association, the Food and Drug Administration (FDA), and Centers for Medicare and Medicaid Services (CMS). Provides routine interaction and ... + Maintains accurate and up-to-date knowledge of all Government Programs regulations ( Medicaid , Medicare , Federal Employee Program, New York State Department of… more
- Catholic Health Services (Rockville Centre, NY)
- …through complex data analysis. The ideal candidate possesses in-depth knowledge of Medicare / Medicaid reimbursement , managed care contracts, and healthcare ... reports and requests. + Prepare and review OASAS/OMH monthly claims and support County audits. + Medicaid ...cost reporting, or financial analysis. + Strong knowledge of Medicare and Medicaid regulations, reimbursement … more