- Access: Supports For Living (Kingston, NY)
- …Collaborate with providers and other healthcare team members, to include the member's payer , in order to facilitate care across the healthcare continuum and optimize ... clinical and financial outcomes. + Maintain a working knowledge of payer requirements. Negotiate on behalf of the member for cost-effective, high quality services… more
- BGB Group (New York, NY)
- …of services, including traditional pharmaceutical advertising, promotional medical education, payer marketing, and consulting services. Known for excellence and ... innovative service offerings, including support for market access, medical education, payer engagement, and promotional campaigns. + Team Development: Build, mentor,… more
- Cardinal Health (Albany, NY)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas,… more
- Northwell Health (New Hyde Park, NY)
- …(LCDs), National Coverage Determinations (NCDs) + Familiarity with common commercial payer policies and reimbursement methodologies. + Coding Systems expertise in ... ICD-10 and HCPCS codes + Strong understanding and application of CMS and AMA CPT guidelines + Understanding of Modifier Usage and correct application of CPT/HCPCS modifiers. + Knowledge National Correct Coding Initiative (NCCI) edits and their impact on claims… more
- Heritage Ministries (Gerry, NY)
- …accurate health and financial information. + Collect accurate data for all payer sources and analyze the information to appropriate placement + Complete ... pre-admission and distribute necessary information to appropriate staff in a timely manner prior to admission. + Act as a liaison between transferring institutions and the facility; establish a good rapport with transferring institutions. + Maintain and… more
- Highmark Health (Albany, NY)
- …data + 1 year of Project leadership in a complex, matrixed environment ( payer and/or provider preferred) + 1 year of Providing analytical consultation to clinical, ... administrative, operational and financial stakeholders **Preferred** + None **SKILLS** + Demonstrated record of data-driven discovery, intense intellectual curiosity, and a passion for working with data to answer important questions about clinical care and… more
- Trinity Health (Albany, NY)
- …as well as supporting SPHPMA, IHANY and Trinity Health's risk adjustment and payer value-based plan initiatives to support revenue and compliance standards in our ... provider group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding, provider auditing and clinical/education experience required. Must have 5 or more years' experience as a risk adjustment auditor and educator and/or clinical documentation… more
- Heritage Ministries (Gerry, NY)
- …requires knowledge of policies, procedures, and regulations of pharmacies and long-term care payer sources. You will find meaningful work in this role with the ... opportunity to collaborate and make a positive impact every day! Apply now! Responsibilities: + Responsible for the management and direction of the Pharmacy personnel and all operations of the pharmacy services. Serves as assigned supervisor to Pharmacy… more
- Highmark Health (Buffalo, NY)
- …combination of experience and education **Preferred** + 6 years of experience in payer , hospital system, or care delivery industry + Experience influencing change in ... complex organizational systems **SKILLS** + Ability to solve complex conceptual and operational problems; potential ability to lead teams in problem-solving exercises + Strong quantitative and analytical skills + Demonstrated influencing, and teamwork skills +… more
- Evolent (Albany, NY)
- …more of the following areas: provider systems, health plan operations, implementations, payer contracting, alternative payment models, delegated risk, or ACOs / CINs ... * Preferred working knowledge of AdaptiveWork (or other project management application), Confluence, JIRA * Preferred PMP project management certification **To comply with HIPAA security standards (45 CFR sec. 164.308 (a) (3)), identity verification may be… more