- Humana (Albany, NY)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional… more
- New York State Civil Service (Middletown, NY)
- …Credentials will be reviewed at the time of interview.Background Investigation/Justice Center Review : In some agencies, the names of all prospective employees will* ... are responsible for payment of all required fees.Medicaid and Medicare : In order to be eligible for appointment and...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 (Thiells, NY)
- …and procedures when needed to ensure the provision of quality care. * Review of lab work, specialty consults, hospital discharges, medical visit summaries and ... the group home, the hospital, the rehabilitation setting and/or community providers.* Review and approval of discharge summaries prior to accepting an individual… more
- New York State Civil Service (Schenectady, NY)
- …clients in that location. Duties would include, but not be limited to review and establish medical histories, perform physical examinations, and manage the medical ... nutrition services to develop individualized therapy plans as necessary.* Review discharge plans from hospitalizations to resume care in...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Intermountain Health (Albany, NY)
- …HIM, PAS, and hospital finance staff as needed. + Prepares monthly Medicare and Medicaid settlement and policy reserve calculations using technically acceptable and ... and exception requests to appropriately maximize reimbursement. Interacts with Medicare Administrative Contractor, State Medicaid, and hospital personnel as needed.… more
- Northwell Health (Westbury, NY)
- …Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare /non- Medicare charts for ... clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding… more
- CVS Health (Albany, NY)
- …**Key Responsibilities** : + Drafting and reviewing product filings: Draft Medicare Supplement and short-term limited duration health insurance products (policies, ... Stay abreast of changes in state and federal regulations related to Medicare supplement insurance. + Record Keeping: Maintain accurate records of product filings… more
- Northwell Health (Westbury, NY)
- …hospital's charge description master. + Oversees and assists in the resolution of Medicare / Medicaid edits generated on hospital outpatient and inpatient Part B ... and maintenance of the charge master and charging philosophy. + Ensures timely review of regulatory literature such as the Federal Register, Medicare … more
- New York State Civil Service (Binghamton, NY)
- …or family therapy; crisis intervention, consultation to other agencies; training and peer review .In addition to the above duties, you may also perform the following ... or release to strict and intensive community supervision and treatment; develop, review , and oversee behavior management plans and/or treatment plans; and develop… more
- Mohawk Valley Health System (Utica, NY)
- …to promote financial stability within the organization. Experience in billing Medicare , Medicaid, Commercial Insurance, HMOs, and Worker's Comp/No Fault is required. ... a plus. Core Job Responsibilities + Responsible for all non- Medicare and Medicare paper and electronic billing....in appropriate agency meetings and quality improvement and utilization review activities of the organization. + Ensure that all… more