- Cardinal Health (Albany, NY)
- …about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while ... High School diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Humana (Albany, NY)
- …residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both ... + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : As part of our… more
- Rochester Regional Health (Rochester, NY)
- …+ Contact physician offices to confirm patient details. Revenue Cycle + Review and scan insurance cards, checking for precertification and payer requirements. + ... + Check insurance eligibility via appropriate websites. + Complete the Medicare Secondary Payer Questionnaire for eligible patients. + Complete all required… more
- CVS Health (Albany, NY)
- …to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... of 1 year recent and related experience in medical record documentation review , diagnosis coding, and/or auditing. + Completion of AAPC/AHIMA training program for… more
- Humana (Albany, NY)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + Proficient ... is higher. **Preferred Qualifications** + Bachelor's Degree + Previous experience in Medicare Advantage or Value-Based Care + AAPC CRC (Certified Risk Adjustment)… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF,… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case ... of admission and stay in accordance with Interqual. ** 2. Prepares Medicare /Non Medicare hospital notices of noncoverage (HINN) when patient's level… more
- New York State Civil Service (Orangeburg, NY)
- …Duties Description The incumbent will perform the following general duties:* Review referral agency reports, document medical histories, and perform psychiatric ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain licensure, certification and/or Medicaid/ Medicare … more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- WelbeHealth (Albany, NY)
- …technical analysis, operations, and internal controls + Oversee the preparation and review process for financial and operational reports required by our core ... + Assist with month-end close, quarterly financial reporting, financial audit, Medicare /Medicaid audits, and other PACE specific projects + Keep a… more