• Lead Analyst, Payment Integrity

    Molina Healthcare (Yonkers, NY)
    …Experience with Medicare , Medicaid, and Marketplace lines of business. + Certified Business Analysis Professional (CBAP), or Certified Coding Specialist ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
    Molina Healthcare (08/20/25)
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  • Sr. Director, Payment Integrity & Cost Containment

    MVP Health Care (Schenectady, NY)
    …in payment integrity or cost containment. + Multi-line expertise (Medicaid, Medicare , Commercial). + Certifications such as: CPC ( Certified Professional ... CCS ( Certified Coding Specialist ), CFE ( Certified Fraud Examiner), CHFP ( Certified Healthcare Financial Professional), Lean Six Sigma, CDEO ( Certified more
    MVP Health Care (08/20/25)
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  • Senior Resident Account Specialst

    St. John's Embrace Living (Rochester, NY)
    Position Summary: The Senior Resident Billing Specialist position reports directly to the Director of Revenue Cycle Management and will assist in the resident ... healthcare business office, physician's office, or insurance billing environment. + Certified Medical Biller experience preferred or must be willing to obtain… more
    St. John's Embrace Living (08/29/25)
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  • Senior Coding Data Quality Auditor, Coding Quality…

    CVS Health (Albany, NY)
    …auditing. + CPC ( Certified Professional Coder) or CCS-P ( Certified Coding Specialist -Physician) required. + Experience with International Classification ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...process and Hierarchical Condition Categories (HCC) required. + CRC ( Certified Risk Adjustment Coder) required within the first six… more
    CVS Health (08/24/25)
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  • Health Plan Operations, Payment Integrity Program…

    Molina Healthcare (Albany, NY)
    …of business. + PMP, Certified Business Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification. + Project Management Experience. + ... At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept...**PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and Marketplace lines… more
    Molina Healthcare (08/14/25)
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  • Clm Resltion Rep III, Hosp/Prv

    University of Rochester (Rochester, NY)
    …experience, or Certification obtained from a nationally accredited billing program (ie, Certified Medical Billing Specialist CMBS, Certified Medical Records ... Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience. Ability to type 25 wpm The… more
    University of Rochester (08/07/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Albany, NY)
    …or more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
    Molina Healthcare (08/15/25)
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  • Recreation Therapist - HOURLY (Kingsboro ATC)

    New York State Civil Service (Brooklyn, NY)
    …individuals in treatment for chemical dependency;Or 3. current credentials as a Certified Therapeutic Recreation Specialist (CTRS) issued by the National Council ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain Medicaid/ Medicare eligibility will result… more
    New York State Civil Service (08/29/25)
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  • Coding Auditor Educator

    Highmark Health (Albany, NY)
    …AHIMA Credentials (Inpatient or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): ... in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine...Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical… more
    Highmark Health (08/08/25)
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  • Outpatient Registered Dietitian

    Saratoga Hospital (Saratoga Springs, NY)
    …or Masters of Science degree in Dietetics or Foods & Nutrition (required) + Board Certified Specialist in Oncology (CSO) or Certified Diabetes Care and ... as a Dietitian-Nutritionist (CDN) with New York State Department of Education; Medicare Provider Number and credentialing through CAQH. Must hold valid NYS driver's… more
    Saratoga Hospital (06/11/25)
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