- University of Rochester (Rochester, NY)
- …management when needed. + Monitors staff performance and develops methods of performance review and quality control. + Provides specific feedback to staff on a ... cross-training staff. + Assists leadership with payer audits, including quarterly Medicare and Medicaid Credit Balance reports and additional credit balance reports… more
- Guthrie (NY)
- …directly to where patients need it most: home. As a 4-star CMS-rated Medicare -certified agency, we deliver skilled nursing, therapy services, social work, and home ... education of healthcare teams, care coordination during hospital stay, documentation review , family and healthcare team discussions, and any other GIP process… more
- Humana (Albany, NY)
- …and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Mount Sinai Health System (New York, NY)
- …+ Associate Degree or High School Diploma/GED + Knowledge of Medicaid, Medicare and commercial insurance billing and ICD/CPT codes for psychiatry services preferred. ... staff to address patient concerns or other coverage and billing issues 10. Review all visit related information in the system for charge accuracy 11. Perform… more
- Humana (Albany, NY)
- …for a health plan. + 5+ years HEDIS and quality measures and ability to review and interpret cost and quality data to drive improvements. + Experience working with ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Mount Sinai Health System (New York, NY)
- …implementation and contract compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as ... be escalated to insurance providers or legal entities for resolution. * Review hospital and professional claims processes to identify gaps and discrepancies,… more
- Elderwood (Waverly, NY)
- …of Medicare and Medicaid Managed Care Policies and Utilization Review . Managed Care Coordinator Skills and Competencies + Demonstrated proficiency with Microsoft ... Office + Bilingual English/Spanish speaking preferred + This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the… more
- Elderwood (Williamsville, NY)
- …other disciplines. + Attends Resident Care Planning and Family/Resident Care Plan Review meetings for residents currently in a speech-language treatment program. + ... inventory. + Submits statistical reports to the Business Office staff for Medicare billing payments, and completes assessment forms upon request. + Attend staff… more
- Molina Healthcare (NY)
- …the solution/project. + Manage moderate project test tasks from requirements review through deployment, including work assignment, prioritization, issue triage etc. ... etc. **PREFERRED EXPERIENCE:** + SQL expertise + Excel expertise + Medicare , Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is… more
- Molina Healthcare (NY)
- …with the standards and requirements established by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal ... into information system and prepares documentation for further review . + Research issues utilizing systems and other available resources. + Assures timeliness and… more