- Highmark Health (Albany, NY)
- …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 ... interpretation, and outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health… more
- Centene Corporation (New York, NY)
- …5+ years of provider reimbursement and analysis experience. Experience with Medicare and Medicaid reimbursement methodology. Managed care experience and provider ... reimbursement, paid time off plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay will be adjusted based on… 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 ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Syracuse, NY)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- Insight Global (New York, NY)
- …or preferring certifications such as CPCS (Certified Provider Credentialing Specialist ) or CPMSM (Certified Professional Medical Services Management). Industry ... on enrolling providers with multiple payers, including commercial, Medicaid, and Medicare . ○ Proven ability to manage high-volume enrollments (5,000+ enrollments… more
- Catholic Health Services (Rockville Centre, NY)
- …discharge planners and primary care providers to ensure continuity of care. Medicare Annual Wellness Visit (AWV) Management + Manage and maintain databases of ... Medicare patients eligible for AWVs. + Conduct telemedicine AWVs,...Conduct proactive care coordination, including: + Appointment scheduling, referrals, specialist /imaging coordination. + Community resource navigation and chronic condition… more
- Northwell Health (Lake Success, NY)
- **Req Number** 169415 Remote Work Schedule: Sun-Thurs or Tues-Sat flexible hours between 7am-7pm Job Description Performs coding and abstracting duties to assure ... online resources: Official Coding Guidelines (OCG), AHA Coding Clinic, Center for Medicare Services and CPT Assistant) to identify appropriate codes and reference… more
- Mount Sinai Health System (New York, NY)
- …**Clinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days-Option to work remote or hybrid.** The Clinical Revenue Auditor for the ... of insurance and governmental programs, regulations, and billing processes (eg, Medicare , Medicaid, etc.), managed care contracts and coordination of benefits is… more
- Healthfirst (NY)
- …eligibility, 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
- University of Rochester (Rochester, NY)
- …information at all times. Location Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at RTP ... are required. Remote location must be within 2 hours of RTP...audits + Coordinate responses and resolution to Medicaid and Medicare credit balances. + Request insurance adjustments or retractions.… more