- New York State Civil Service (Staten Island, NY)
- …treatment planning.* Participating in multidisciplinary case discussions, high- risk reviews, and administrative meetings.* Maintaining clinical documentation ... will be required.This position is eligible for a Downstate adjustment of $4,000.NOTE: 1. In order to be eligible...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and ... + Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements. + Leads...statements for assigned business segments. + Leads preparation of Medicare Advantage bids and coordinates CMS bid review responses.… more
- Deloitte (New York, NY)
- …reimbursement, MS-DRG, APR-DRG, PSIs, HACs, POA, Vizient, Elixhauser, public profiling, and risk adjustment + Has strong interpersonal skills to collaborate with ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk … more
- Molina Healthcare (Buffalo, NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... clinical performance is achieving desired results. * Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. * Supports scoreable action… more
- Molina Healthcare (Buffalo, NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Buffalo, NY)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- New York State Civil Service (NY)
- …treatment and expert testimony. * Specialized assessment (functional, personality, risk , competency, vocational, education) * Design and application of behavioral ... hiring rate ($25,077), Geographic Pay Differential ($20,000), and Downstate adjustment ($4,000). The Geographic Pay Differential and Downstate adjustment… more
- Molina Healthcare (Yonkers, NY)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work… more
- Humana (Albany, NY)
- …with corporate and market teams, including IT, Quality Operations and Compliance, and Risk Adjustment , as well as vended partners. The Senior HEDIS Operations ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Albany, NY)
- …Electronic Medical Records, and/or Electronic Notifications. + Familiarity with CMS Risk Adjustment and Quality Measure Reporting. + Experience in ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more