- Highmark Health (Albany, NY)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job is responsible for key strategic initiatives for the Markets and Provider Transformation ... share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing… more
- Highmark Health (Buffalo, NY)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This role is a hybrid role in the Greater Buffalo Area with offsite travel up to 50% in the Buffalo ... a result of workflow transformation, superior coding accuracy, and Medicare STARS gap closure to providers based upon each...set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees… more
- Cardinal Health (Albany, NY)
- …inquiries and concerns in a timely manner + Enter detailed information into company proprietary software while conversing via telephone + Place outbound phone calls ... or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for...level** : + Effectively applies knowledge of job and company policies and procedures to complete a variety of… more
- Molina Healthcare (Albany, NY)
- …that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the ... have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has...to determine if any provider has opted out of Medicare . * Reviews and processes daily NPDB Continuous Query… more
- Cardinal Health (Albany, NY)
- …you and others at this level_** + Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments + In-depth knowledge ... + Cell/Gene therapy and/or Oncology experience, preferred + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies, preferred… more
- Humana (Albany, NY)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...Board + Leads strategic planning efforts to develop a specialist network within the ACO + Develops a health… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …irregularities; determining continuing needs for Tele-Sale Agents, Benefit Navigators and Medicare Support Specialist . + Ensure all Tele-sale Agents, Benefit ... Navigators, and Medicare Support Specialists are conducting activities that are in...conducting activities that are in compliance with CMS/DOH and company guidelines by directly reporting to the Training Director… more
- Centene Corporation (Queens, NY)
- …Teams and / or activities / clinical documentation submitted by the Intake Specialist . The Clinical Quality Assurance RN will review for to confirm accuracy and ... (CDOH), Local Department of Social Services and Center for Medicare & Medicaid Services (CMS). The Clinical Quality Assurance...will spend time in the field while reviewing Intake Specialist work and will actively coach and develop staff… more
- CVS Health (Albany, NY)
- …passionate about transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local presence, digital ... applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are… more
- Adecco US, Inc. (Syracuse, NY)
- **Job Title:** Lead Claims Specialist **Location:** Syracuse, NY **Job Type:** Contract to hire **Pay Rate:** $42 - $45 per on w2. Position Overview: We are seeking ... a detail-oriented and experienced **Lead Claims Specialist ** to manage complex and high-exposure claims. This role...Handle claim recoveries including subrogation, Second Injury Fund, and Medicare offsets. + Report claims to excess carriers and… more