- 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
- University of Rochester (Rochester, NY)
- …audits, and third-party payor audits + Coordinate responses and resolution to Medicaid and Medicare credit balances + Review all accounts on the Medicaid and ... Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro)… 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 corrects ... 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
- 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...the account to a self-pay financial class after a review of previous efforts has not resulted in revenue… more
- New York State Civil Service (Buffalo, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a license ... HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Greater Binghamton Health Center, P26033...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- New York State Civil Service (Bronx, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a license ... HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Molina Healthcare (Buffalo, NY)
- …the benefits, operations, communication, reporting, and data exchange of the Medicare /MMP product in support of strategic and corporate business objectives. Support ... for all Medicare lines of business the annual Medicare ...Marketing Guidelines, initiating HPMS submission of materials for CMS review when required. Provides oversight and update of the… 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
- MVP Health Care (Schenectady, NY)
- Leader, Medicare Field Sales Headquarters Office, 625 State Street, Schenectady, New York, United States of America Req #2531 Tuesday, April 8, 2025 At MVP Health ... improvement. To achieve this, we're looking for a **Leader, Medicare Field Sales** to join **\#TeamMVP** . This is...adheres to CMS regulations and corporate compliance policies. + Review applications in CRM (Dynamics 365) to ensure data… more