- Evolent (Albany, NY)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- HCR Home Care (Rochester, NY)
- …as resource for problem-solving or advising on patient care questions or concerns. + Review and approve all new interim orders before they are sent to physician. ... intervention and g oals for d ocumentation to include vital sign alert . + Review missed visit reports, ensure MD notification has occurred and , if not, notify MD.… more
- Stony Brook University (Commack, NY)
- …by the MCO within timeframes required by MCO. + Gather and review data for reporting purposes to meet MCE delegated credentialing contractual obligations. ... notice from the MCO, furnish the report or roster review within the timeframe required by delegated credentialing agreement....or payer. + Direct experience with NYS Medicaid and Medicare enrollment and recertification. + Experience setting up and… more
- Trinity Health (Albany, NY)
- …documentation improvement specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as ... the overall quality, accuracy and integrity of documentation through extensive record review , reporting, trending and education. + Serves as a resource for… more
- New York State Civil Service (Orangeburg, NY)
- …physical ability, and/or rehabilitative and clinical needs of individuals. * Review and evaluate program effectiveness and recommending program changes or ... specialized activities as needed.* Attend and participate in treatment plan review sessions providing input as relates to the program participants participation in… more
- Molina Healthcare (Yonkers, NY)
- …administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care ... of deliverables/submission between staff and governmental agencies and contract review . * Maintains calendar and databases documenting regulatory filings, approvals… more
- WMCHealth (Valhalla, NY)
- …requests for specialty medications, tracking expiring authorizations and renewals + Review claims and rejections to determine required follow-up, ensuring timely ... & Quality Assurance: + Ensure all activities are compliant with HIPAA, Medicare /Medicaid billing regulations, and the 340B Drug Pricing Program + Participate in… more
- Datavant (Albany, NY)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Stony Brook University (Stony Brook, NY)
- …Revenue Cycle Management is responsible for the development, implementation, maintenance, review and audit of the Hospital Charge Description Master to optimize ... charge capture audits utilizing both software tools and/or EMR and documentation review . May assist in the resolution of pre-billing charging issues and post-payment… more
- Mohawk Valley Health System (Utica, NY)
- …barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, ... appropriateness of admission and continued stay, severity, and morbidity/mortality. + Review patient status when admission criteria is non-sufficient for admission.… more