- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Elevance Health (East Syracuse, NY)
- … of complex exception requests and CMS change requests. + 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...experienced associates as assigned. + Prepare and perform supervisory review of cost report desk reviews and audits. +… more
- Humana (Albany, NY)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a… more
- Humana (Albany, NY)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a… more
- Healthfirst (NY)
- …of business + Provide support for annual Medicare bids for all Healthfirst's Medicare products + Review and quantify any regulatory / CMS proposals and/or ... or any related degree + Experience in the actuarial field related to Medicare (bid development/ review , analysis, reporting, risk scores) + Ability to collect,… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- Actalent (Syracuse, NY)
- …Responsibilities + Review clinical trial protocols and budgets to determine Medicare coverage. + Analyze billing details to ensure compliance with federal rules. ... Medicare Coverage Analyst - MUST RESIDE IN NY Job Description The Medicare Coverage Analyst is responsible for reviewing clinical trial protocols and budgets to… more
- University of Rochester (Rochester, NY)
- …patients COBRA entitlement and assist with paperwork if necessary. **_Compliance_** + Review Medicare for MSP questions and validations. Investigates and ... to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role… more
- 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 (East Syracuse, 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