- Excellus BlueCross BlueShield (Rochester, NY)
- …accessing Health Plan to perform medical review, obtains case or disease management support , or otherwise interacts with Health Plan programs and services. + Makes ... managed care benefit plans and strong knowledge of government program contracts ( Medicare and Medicaid) and benefits, preferred. + Strong written and verbal… more
- Heath System Services (Niagara Falls, NY)
- …medical necessity qualification, and prior authorization. + Maintain adherence to Medicare , Medicaid, and commercial payer standards. + Act as a resource ... accurate data entry. + Collaborate with IT or system support teams to resolve technical issues impacting workflows. Reporting...Generous PTO, Vacation and 9 Paid Holidays + Extra Support When You Need It - Short Term Disability… more
- WellLife Network (Smithtown, NY)
- …Services to coordinate care for shared clients, improve service integration and support continuity of care across settings. + Staffing and Workforce Development: + ... + Monitor staff documentation practices to ensure compliance with Medicaid, Medicare , and private insurance billing requirements. + Implement productivity benchmarks… more
- Robert Half Finance & Accounting (Syracuse, NY)
- …provide insights to department leaders. * Manage regulatory filings, including Medicare cost reports and state-specific financial disclosures, with precision. * ... entries, accruals, and intercompany transactions to ensure proper documentation. * Support the budgeting, forecasting, and financial planning processes to align with… more
- Elderwood (Buffalo, NY)
- …the community outside of the scope of services MLTC provides to support social determinants of health. + Interacts continuously with members, family, physician(s), ... and other resources to determine appropriate behavioral action needed to address/ support medical needs. + Reviews benefits options, research community resources,… more
- Healthfirst (NY)
- …organizational and regulatory standards for proper function, quality, and in support of enhancing Member/Provider service experiences. + Experience applying critical ... staff engagements and monthly team meetings. + Ensure team support and adheres to all improvement initiatives. + Provide...least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus,… more
- Northwell Health (Lake Success, NY)
- …obtains appropriate clinical documentation for all clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and ... of care provided. Responsible for concurrent inpatient medical record reviews for Medicare , Medicaid and all commercial payers. Generates queries and have follow up… more
- Staffing Solutions Organization (Albany, NY)
- …various information systems to collect/organize, run, and analyze data; providing support for administrative fair hearings and other procedural processes for ... professional experience in public health insurance programs, including Medicaid, Medicare and/or Child Health Plus. Preferred candidates will also...F-1 STEM EAD program, SSO may be able to support a STEM EAD extension application at the sole… more
- University of Rochester (Brighton, NY)
- …must make complex decisions. May train new or less experienced support staff. Schedule: M-F 8:30am-5pm **ESSENTIAL FUNCTIONS** Reception: + Greets patients ... completion of all appropriate forms by patients, such as, Medicare Secondary Payer assurance, provision of HIPAA information for...Create - and Make the World Ever Better. In support of our values and those of our society,… 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 ... ensure compliance with company policies and regulatory requirements, including support for regulatory inquiries and external investigations related to third-party,… more