- CVS Health (Albany, NY)
- …trend and report on vendor performance data. + Familiarity with Medicare and Medicaid regulations. **Education** + Associates degree or equivalent experience. ... **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within… more
- Baylor Scott & White Health (Albany, NY)
- …a timely way. . Responds to inquiries and guidance requests utilizing applicable Medicare and Medicaid rules and regulations. Serves as a compliance resource to BSWH ... departments and entities on compliance matters. KEY SUCCESS FACTORS . Continually demonstrates initiative by learning business processes and applicable auditing techniques. . Ability to exercise good judgment, attention to detail, integrity, dependability, and… more
- CVS Health (Albany, NY)
- …with provider engagement, relations, or account management. + Working knowledge of Medicare contracts. + An understanding of value based contracts, how they work, ... what is the value. + Strong presentation skills, the ability to communicate effectively. + Mastery of problem solving and decision making skills + Strong MS Office skills. Preferred Qualifications: + The ability to use data to tell a story. + Mastery of growth… more
- CVS Health (Albany, NY)
- …years Industry experience in mental or behavioral health, payer, commercial, and Medicare + Proven ability to interact with, influence and collaborate with business ... leaders and producing managers at all levels + PMP certification + Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity **Education** + Bachelor's degree or equivalent professional work experience **Pay… more
- Ankura (New York, NY)
- …of in claims processing procedures, state and federal regulations, and Medicare Part D requirements. + Excellent written and verbal communication skills, ... ability to work in a remote environment, and time management skills. + Prior success in managing small projects and teams and able to Ability to be able work on multiple client projects simultaneously, if needed. + Ability to work in a fast-paced environment… more
- Trinity Health (Schenectady, NY)
- …of trends in healthcare, combining an insurance role (we are the Medicare /Medicaid insurer for our participants) with a comprehensive healthcare provider role ... (primary care, home health, adult daycare, transportation, all coordinated by an interdisciplinary team). The primary purpose of this job position is to provide skilled nursing care and prescribed treatments to participants according to professional nursing… more
- Baylor Scott & White Health (Albany, NY)
- …are completed in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and ... entities on compliance matters. _Third Party Compliance_ . Assists in assessing and mitigating risks related to third-party relationships, including bribery, corruption, sanctions, and reputational concerns. . Supports the implementation and maintenance of… more
- Trinity Health (Schenectady, NY)
- …transportation and more!) as well as provide our participants with their Medicare /Medicaid insurance coverage. Our team of Social Workers are supported by two ... Case Workers and play a crucial role in our unique model of care. As both the provider and insurer, we have the unique ability to assess participant needs, approve it and directly provide it. We coordinate care across settings-from home to ED/hospital, rehab,… more
- Molina Healthcare (Yonkers, NY)
- …existing healthcare quality improvement initiatives and education programs supporting Medicare Star Ratings improvement for Clinical HEDIS measures. Responsible for ... of improvement strategies to ensure high level of performance across Medicare Stars clinical HEDIS programs. Leads enterprise partnership discussions and improvement… more
- Humana (Albany, NY)
- …our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates ... Medicare Advantage and Prescription Drug Plans using approximately 40...Act as a first point of contact keeping the senior leaders aware of unanticipated problems or opportunities with… more