- Healthfirst (NY)
- …of business + Provide support for annual Medicare bids for all Healthfirst's Medicare products + Review and quantify any regulatory / CMS proposals and/or ... or any related degree + Experience in the actuarial field related to Medicare (bid development/ review , analysis, reporting, risk scores) + Ability to collect,… more
- Humana (Albany, NY)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- Humana (Albany, NY)
- …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- University of Rochester (Rochester, NY)
- …patients COBRA entitlement and assist with paperwork if necessary. **_Compliance_** + Review Medicare for MSP questions and validations. Investigates and ... to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...reports:- - - 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over… more
- Humana (Albany, NY)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. + Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... final resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of...the account to a self-pay financial class after a review of previous efforts has not resulted in revenue… more
- Arnot Health (Bath, NY)
- …of the Long Term Care staff, attends weekly care conference meetings, and weekly Medicare A review with care team and therapies. + Demonstrates effective time ... of resident care. e. Assists the DON with implementing appropriate review systems for competency-based appraisals of staff. f. Participates in Nursing/Medical… more
- Molina Healthcare (Rochester, NY)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- CVS Health (New York, NY)
- …all with heart, each and every day. **Position Summary** Within CVS Health, Aetna Medicare brings essential care to the nation's seniors and is a critical growth ... creativity and strategic thinking to our work. The Sr. Marketing Manager, Medicare Acquisition Marketing will support the development and execution of cross-channel… more