• Utilization Review Nurse

    Albany Medical Center (Albany, NY)
    …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
    Albany Medical Center (04/25/25)
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  • Patient Account Assoc II Credit Balance & Account…

    Intermountain Health (Albany, NY)
    …cycle (Payment Posting, Billing, Follow-Up) required + Knowledge of Medicaid and Medicare billing regulations required + Two (2) years of experience in hospital ... or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections) preferred **Physical Requirements** + Operate computers and other office equipment requiring the ability to move fingers and hands. + Remain sitting or… more
    Intermountain Health (05/28/25)
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  • Processor, COB Review

    Molina Healthcare (Yonkers, NY)
    …Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. **JOB QUALIFICATIONS** **Required Education** HS Diploma ... or GED **Required Experience** 1-3 years' experience in an administrative support. **Preferred Education** Associate degree **Preferred Experience** 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested… more
    Molina Healthcare (05/25/25)
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  • Clinical Quality Manager

    Healthfirst (NY)
    …institution + Clinical license: LPN, RN, LMSW or LCSW + Multiple years of HEDIS review experience for both Medicaid and Medicare lines of business + Medical ... management + Assists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promotions for the HF newsletter + Assists and… more
    Healthfirst (05/31/25)
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  • VP Controller

    Bassett Healthcare (Cooperstown, NY)
    Medicare Cost reporting. . Identify unique funding levels in Medicaid and Medicare based on rural provider status. . Review information used in development ... . Oversee completion of Network Hospital IRS form 990 Schedule H. . Review budget variance's with hospital departments in areas of volume, revenue and expense.… more
    Bassett Healthcare (05/20/25)
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  • Audit & Reimbursement Senior- Appeals

    Elevance Health (East Syracuse, NY)
    …+ Assist in mentoring less experienced associates as assigned. + Perform supervisory review of workload involving complex areas of Medicare part A reimbursement ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...all cost based principles. + Prepare and perform supervisory review of cost report reopenings. + Manage caseload of… more
    Elevance Health (05/30/25)
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  • Mgr, Sales-Ohio

    Molina Healthcare (Yonkers, NY)
    …and production of the annual marketing strategy and objectives for Molina Medicare 's portfolio of Medicare products. + Responsible for supporting the ... + Developing, implementing, improving, and maintaining Marketing Operations for Molina Medicare . + Directing and analyzing Market Research Activities for Molina … more
    Molina Healthcare (05/02/25)
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  • Audit & Reimbursement III- Appeals

    Elevance Health (East Syracuse, NY)
    …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... programs. The **Audit and Reimbursement III** will support our Medicare Administrative Contract (MAC) with the federal government (The...directed by management. + Participates in special projects and review of work done by auditors as assigned. +… more
    Elevance Health (05/30/25)
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  • Director, Appeals & Grievances (Texas)

    Molina Healthcare (Yonkers, NY)
    …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
    Molina Healthcare (05/16/25)
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  • Audit & Reimbursement II (US)

    Elevance Health (East Syracuse, NY)
    …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... federal health programs. The **Audit and Reimbursement II** will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for … more
    Elevance Health (05/30/25)
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