- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Ultimate Care Inc (Brooklyn, NY)
- …not to be covered and obtain necessary patient signatures. + Reimbursement Review : Review Medicare reimbursement schedules and fee-for-service structures. ... Specialist will be responsible for managing the billing and collections process for Medicare /Medicaid Managed Care claims. You will work closely with our finance and… 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. Involves… 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 ... 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
- 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
- University of Rochester (Rochester, NY)
- …sterilization/hysterectomy consent form for compliance if missing from EMR. + Compliance + Review Medicare for MSP questions and validations. + Ensure compliance ... missing PCP, and incorrect effective dates for newborn and NICU cases. + Review each Maternity admission for insurance history by utilizing the hospital system along… more