- CenterWell (Hauppauge, NY)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and...documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and… more
- Saratoga Hospital (Saratoga Springs, NY)
- …federal and accreditation requirements, including but not limited to the Centers for Medicare and Medicaid (CMS) and the Joint Commission (JC), DNV, OSHA, CMS and ... survey coordination, offsite mock surveys, unannounced surveys and assists with the review of regulatory standard crosswalks for every dept. in the organization as… more
- HCR Home Care (Rochester, NY)
- …and management of the Accounting and Finance Departments. Essential Functions * Review business strategy and evaluate its financial viability. * Develop and ... transactions are recorded in accordance with generally accepted accounting principles. * Review the financial statements on a timely basis and address issues… more
- Centene Corporation (New York, NY)
- …healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the ... cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and… more
- Bassett Healthcare (Cooperstown, NY)
- …of Advanced Beneficiary Notice signatures and form processing to meet Medicare regulations. Ensures all corrections (demographics, insurance eligibility etc.) based ... from providers or other staff to adjust appointment schedules to Supervisor for review and approval before acting, as noted by Supervisor. Reviews the electronic… more
- Stony Brook University (Stony Brook, NY)
- …for submission to the Department of Veteran's Affairs. + Completes notification to Medicare beneficiaries for changes in level of care (SNF ABN, NOMNC). + Completes ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Stony Brook University (East Setauket, NY)
- …+ Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge of third ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Stony Brook University (East Setauket, NY)
- …hospital Managed Care payment variances and denials. + Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies. + Expert ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for the following programs, including but not limited to: * Prospective medical record review of health plan providers * Retrospective medical record review of ... were correctly reimbursed and documented. Reports findings of the data validation review . Prepares and submits adjustments to the appropriate processing / adjustment… more
- Stony Brook University (East Setauket, NY)
- …Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + Knowledge of ... or for a maximum of 90 days. An initial review of all applicants will occur two weeks from...full consideration, applications must be received before the initial review date (which is within two weeks of the… more