- Molina Healthcare (Yonkers, NY)
- …solutions. + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
- Bassett Healthcare (Cooperstown, NY)
- …via mail, phone, or MyBassett to meet patient satisfactions. Takes a lead in service recovery , and acts as a service liaison in the moment. Acts as a trainer for ... is entered or scanned into the system accurately as monitored by system audit Accurate confirmation of attending PCP and Billing PCP, when appropriate. Assures… more
- MVP Health Care (Schenectady, NY)
- …contracts and ensure accountability. + Track and report key metrics such as recovery rates, audit turnaround times, and dispute resolution outcomes. **Fraud, ... **Vendor Management & Performance Monitoring** + Manage external vendors supporting audit , analytics, and fraud detection. + Monitor vendor performance against SLAs… more
- WellLife Network (Smithtown, NY)
- …Mental Health Clinics, Substance Use Disorder (SUD) Clinics, and Personalized Recovery Oriented Services (PROS). This executive-level role is responsible for driving ... and Operational Leadership: + Provide visionary leadership to ensure high-quality, recovery -oriented care across all assigned programs. + Develop and implement… more
- Mohawk Valley Health System (Utica, NY)
- …Provide peer-to-peer payor review in collaboration with attending physicians. + Support Recovery Audit Contractors (RAC's). + Assist with mitigating barriers to ... clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as… more
- Project Renewal, Inc. (Brooklyn, NY)
- …Withdrawal Services, (MSOWS), Chemical Dependency Crisis Service (CDCS), and Outpatient Recovery Center available to them throughout the agency. Essential Duties & ... breakdowns and assign new clients to Case Managers. + Audit client charts weekly to ensure adherence to regulatory...Advises clients of entitlement possibilities and refers them for Medicaid/ Medicare , Public Assistance, & Food Stamps as needed. +… more