- CVS Health (Albany, NY)
- …Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance ... and pricing. The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies.… more
- Healthfirst (NY)
- …and following up on outstanding deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including tracking ... reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
- Stony Brook University (Stony Brook, NY)
- …all pharmacy cash receipts in QS1 system and monthly closing functions. + Enroll residents in Medicare Part D plans. + Oversee all banking for the residents. ... **may include the following but are not limited to:** + Billing for Medicare ( Part A & B), Medicaid, Private, Insurance, NAMI, Physician, and Adult Day Health… more
- World Insurance Associates, LLC. (New York, NY)
- …open items and deliver notes to client (includes compliance needs including 5500 filing, Medicare Part D Disclosures, Reporting, HIPAA, ERISA, COBRA) + ... Engage with clients to educate on market trends, carrier and vendors solutions, EB SME and World capabilities (not just day-to-day service) + Manage vendor/carrier performance and escalated service issues + Finalize and deliver Stewardship report and messaging… more
- WelbeHealth (Albany, NY)
- …of capitation payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D ) along with PACE rates and regulatory ... + Assist with month-end close, quarterly financial reporting, financial audit, Medicare /Medicaid audits, and other PACE specific projects + Keep a… more
- Centene Corporation (Queens, NY)
- …performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans ( D -SNPs). The Manager will serve as a subject matter expert in Medicare ... Act as a strategic advisor on contract structure and payment methodologies for Medicare Advantage and D -SNP providers, supporting new contract negotiations and… more
- Northwell Health (Westbury, NY)
- …Job Description Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist-Clinical. Conducts ... the documentation in the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained in… more
- Pfizer (New York, NY)
- …to learn or have a general working knowledge of Managed Care (Commercial, Part D , Medicare , Medicaid, Healthcare Insurance Exchanges), general concepts ... of healthcare law and regulations, and how Government Pricing may be impacted by Commercial contracting, in order to develop contract proposals and agreements that maximize product utilization and profitability while ensuring compliance with all laws and… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us...as we prepare for the launch of Fully Integrated D -SNP (FIDE) plan in 2026. This individual will focus ... put health first** The MBA Intern - Illinois Medicaid ( Part -time, Fall 2025) will contribute as a team member while completing a full-time MBA program. The paid… more
- Amgen (New York, NY)
- …expertise in Medicare ( Part B - for buy & bill products and Part D for Pharmacy products). + Ability to manage ambiguity and problem-solve + Ability to ... Serving Patients** At Amgen, if you feel like you're part of something bigger, it's because you are. Our...the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for… more