- New York State Civil Service (Dix Hills, NY)
- …State NY Zip Code 11746 Duties Description The Quality & Risk Management Specialist will play a critical role in Quality Management and Risk Management functions ... on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal...appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a… more
- Molina Healthcare (NY)
- …oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School ... regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part D, Medicaid,… more
- Humana (Albany, NY)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...or similar pharmacy practice experience + Board Certified Pharmacotherapy Specialist (BCPS) + MBA, pharmacoeconomics or health outcomes training… more
- Northwell Health (Lake Success, NY)
- …online resources: Official Coding Guidelines (OCG), AHA Coding Clinic, Center for Medicare Services and CPT Assistant) to identify appropriate codes and reference ... as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations. 7.Make...One or more of the following required: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified… more
- New York State Civil Service (Brooklyn, NY)
- …chemical dependency;Or 3. current credentials as a Certified Therapeutic Recreation Specialist (CTRS) issued by the National Council For Therapeutic Recreation ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain Medicaid/ Medicare eligibility will result… more
- Healthfirst (NY)
- …exclusion, and exemption codes.** + **Searches in Marx (CMS) for Medicare eligibility, enrollments, and special elections.** + **Achieves daily, weekly, and ... all field and tele video conference appointments for HF CompleteCare Specialist and Intake Nurses in Salesforce.** + **Schedules Entitlement Advocates appointments… more
- Molina Healthcare (Buffalo, NY)
- …Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically ... appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret… more
- Molina Healthcare (Albany, NY)
- …compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... delegated groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality… more
- Evolent (Albany, NY)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Mount Sinai Health System (New York, NY)
- …of insurance and governmental programs, regulations, and billing processes (eg, Medicare , Medicaid, etc.), managed care contracts and coordination of benefits is ... Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Healthcare Auditor (CHA) can be beneficial.… more