• Clm Resltion Rep III, Hosp/Prv

    University of Rochester (Rochester, NY)
    …and all audits + Coordinate responses and resolution to Medicaid and Medicare credit balances. + Request insurance adjustments or retractions. + Review and ... Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not… more
    University of Rochester (08/07/25)
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  • Network Optimization Coordinator

    CDPHP (Latham, NY)
    …as assigned Qualifications: + 3 years managed care experience with commercial, Medicare and Medicaid lines of business and regulatory requirements + Associates ... and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC. more
    CDPHP (08/03/25)
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  • Patient Acct Clerk

    WMCHealth (Poughkeepsie, NY)
    …Provider Solutions Inc. City/State: Poughkeepsie, NY Category: Clerical/Administrative Support Department: Patient Accounts-WMC Health Union: No Position: Full ... Knowledge of Patient management System(s), payer websites, medical terminology, Medicare medical necessity and commercial authorizations. Microsoft office products… more
    WMCHealth (08/02/25)
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  • Denials Specialist

    WMCHealth (Hawthorne, NY)
    …NorthEast Provider Solutions Inc. City/State: Hawthorne, NY Category: Clerical/Administrative Support Department: Business Office Union: No Position: Full Time ... + Demonstrated knowledge of healthcare management, collections management, Medicaid and Medicare . + Experience in establishing and managing claim denial activities,… more
    WMCHealth (08/02/25)
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  • Transition of Care Nurse LPN

    Premier Medical Group of the Hudson Valley (Poughkeepsie, NY)
    …mail messaging systems, email, and use of various software applications to support operational processes. + Maintain appropriate training levels for duties and ... to detail, and exercise professional work ethics. + Familiarity with applicable Medicare and Medicaid programs preferred. + Understanding of HIPAA, Privacy, Safety,… more
    Premier Medical Group of the Hudson Valley (07/31/25)
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  • Lead Enterprise AI/ML DevOps Engineer

    Humana (Albany, NY)
    …its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (07/29/25)
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  • Advanced Practice Provider-PD

    Catholic Health Services (Roslyn, NY)
    …on Long Island to receive a five-star rating from the Centers for Medicare & Medicaid Services for consistently high patient satisfaction scores. Job Details An ... outcomes. Address patient concerns, answer questions, and provide emotional support . Maintain accurate and up-to-date electronic medical records, documenting patient… more
    Catholic Health Services (07/29/25)
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  • Senior Risk Partner - Compliance Officer

    Highmark Health (Albany, NY)
    …enterprise risk taxonomy. Through matrixed leadership with Risk Operations and with support from Risk Enablement, the incumbent monitors and tracks the delivery of ... and cross-functional strategy development. + Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance… more
    Highmark Health (07/29/25)
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  • Auditor, Risk Adjustment (Remote)

    Molina Healthcare (Buffalo, NY)
    …chart retrieval, file transmissions, and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, ... and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment… more
    Molina Healthcare (07/25/25)
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  • CNA

    WMCHealth (Margaretville, NY)
    …Mountainside Residential Care Center City/State: Margaretville, NY Category: Nursing Support Department: Skilled Nursing Union: Yes Union Name: UFCW Position: ... award-winning 82-bed enhanced care facility. We have received a 5-Star rating from Medicare 's "Nursing Home Compare" and 5-star ratings in US News & World Report's… more
    WMCHealth (07/25/25)
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