- Humana (Albany, NY)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + Proficient ... is higher. **Preferred Qualifications** + Bachelor's Degree + Previous experience in Medicare Advantage or Value-Based Care + AAPC CRC (Certified Risk Adjustment)… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF,… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case ... of admission and stay in accordance with Interqual. ** 2. Prepares Medicare /Non Medicare hospital notices of noncoverage (HINN) when patient's level… more
- New York State Civil Service (Orangeburg, NY)
- …Duties Description The incumbent will perform the following general duties:* Review referral agency reports, document medical histories, and perform psychiatric ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain licensure, certification and/or Medicaid/ Medicare … more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- Elevance Health (New Hyde Park, NY)
- …actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an Impact** Primary duties ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven analyses… more
- WelbeHealth (Albany, NY)
- …technical analysis, operations, and internal controls + Oversee the preparation and review process for financial and operational reports required by our core ... + Assist with month-end close, quarterly financial reporting, financial audit, Medicare /Medicaid audits, and other PACE specific projects + Keep a… more
- Project Renewal, Inc. (New York, NY)
- …with federal, state, and local healthcare regulations (eg, HIPAA, Stark Law, Medicaid/ Medicare , Part 2). + Ensure the organization's compliance program meets FQHC ... or Article 28 experience strongly preferred). + Strong knowledge of HIPAA, Medicaid/ Medicare , Stark Law, Part 2, and healthcare regulatory standards. + Analytical… more
- Molina Healthcare (NY)
- …Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing ... in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model… more
- Catholic Health Services (Rockville Centre, NY)
- …complete assigned reports and provide accurate and timely information for review by the Director of Reimbursement or their designee. DUTIES/RESPONSIBILITIES: ... care analysis, home office cost reports, budget capital reports, and various Medicare / Medicare cost report schedules, working alongside Director and Staff.… more