- Ankura (New York, NY)
- …is a team of excellence founded on innovation and growth. Ankura's Disputes & Economics professionals are world class and globally recognized independent experts ... who tailor financial, operational, and compliance solutions to complex litigation, enforcement, and regulatory challenges....Director will support the Healthcare Payer team within Ankura's Disputes & Economics practice - one of seven practices… more
- Ankura (Lexington, NY)
- …A recognized leader in healthcare litigation support, Ankura's Healthcare Disputes team combines unparalleled clinical, technical, and operational experience with ... analytical offerings for our clients that reveals how this information impacts legal disputes that these companies may be facing. We combine in-depth operational, … more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** Code Edit Disputes team reviews and educates providers when there is a dispute on ... millions of people we serve to achieve their best health - delivering the care and service...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Western Digital (Albany, NY)
- …in data. **Job Description** **Position Summary** We are looking for a **Retail Compliance Specialist** to join the Western Digital Fulfillment Operations Team to be ... strong communication skills. **Essential Duties and Responsibilities:** + Experience with retail compliance and penalty programs (eg, Walmart's OTIF - On Time In… more
- CVS Health (Albany, NY)
- …consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions ... At CVS Health , we're building a world of health...The Medicaid VBS Network State Manager manages and oversees compliance with our Network responsibilities as provided within the… more
- University of Rochester (Brighton, NY)
- …Senior Counsel identifies, analyzes and provides legal guidance and services on complex health care regulatory and corporate matters relevant to the University ... of Rochester Medical Center (Medical Center) and its health care affiliates, including hospitals, long term care facilities, home health agencies,… more
- Humana (Albany, NY)
- …Follows established guidelines/procedures. + Complete medical record reviews for Behavioral Health Inpatient and Outpatient Provider Disputes + Cross train ... in Physical Health Provider Disputes based on the business need + Review and...Qualifications** + Bachelor's degree in nursing (BSN) + Behavioral Health and/or Utilization Management experience + Acute care… more
- Humana (Albany, NY)
- …Humana processes, as well as a focus on collaborative business relationships, value based care , population health , or disease or care management. **Use your ... of service should be authorized at the Initial and Appeals/ Disputes level. All work occurs within a context of...millions of people we serve to achieve their best health - delivering the care and service… more
- Molina Healthcare (Rochester, NY)
- …to review compliance -based issues for benefit planning purposes. **Recoveries & Disputes ** + Review and validate provider complaints and payment disputes , ... disputes , appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical...years of experience in previous roles in a managed care organization, health insurance or directly adjacent… more
- Mount Sinai Health System (New York, NY)
- …advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific ... integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative… more
- Mount Sinai Health System (New York, NY)
- …degree preferred + 4 years of insurance billing and collection procedures in a health care environment + Excellent written, verbal and interpersonal skills + ... charges in accordance with established fee schedules and ensures compliance with Medicare and other insurance carrier guidelines. **Qualifications**...all people, everywhere, by taking on the most complex health care challenges of our time -… more
- BrightPath Early Learning & Child Care (West Seneca, NY)
- …lead HR functions including employee relations, enforcing company policies, and resolving disputes in the workplace. As an HR Manager you will encourage everyone ... Employee Relations and Chief Human Resources Officer. * Maintaining compliance with federal, state, and local employment laws, regulations,...BrightPath Kids USA: * We offer a 60% child care discount to ALL employees so that your family… more
- Intermountain Health (Albany, NY)
- …claims and/or patient issues. Investigates and resolves claims submission, disputes or complaints to resolution, as needed. Resolves billing/insurance issues ... and ensures compliance with departmental and governmental policies. + Supports the...standards. + Promotes mission, vision, and values of Intermountain Health , and abides by service behavior standards. + Performs… more
- CVS Health (Albany, NY)
- …consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions ... At CVS Health , we're building a world of health...+ Negotiate and manage contracts with pharmaceutical manufacturers, ensuring compliance , tracking performance metrics, and resolving disputes .… more
- University of Rochester (Rochester, NY)
- …the world ever better. If you're looking for a career in higher education or health care , the University of Rochester may offer the perfect opportunity for your ... contract governance, change orders, renewals, assists in obligation management and handles disputes in the best interest of the University. Evaluates contract … more
- New York State Civil Service (Albany, NY)
- …Manage the carrier invoice dispute process, including opening and closing disputes based on validation of monthly-recurring invoices.* Process non-recurring invoices ... This involves validating against approved ITSM requests and ensuring contract rate compliance . ITSM Processing and Technical Support* Process and close ITSM requests… more
- Hillside Family of Agencies (Rochester, NY)
- …a particular service and assists the Nurse Manager with administrative management of the health care services team. This role is also responsible for providing ... health care oversight and medical ...confidentiality. Discuss confidential matters in an appropriate manner in compliance with the Health Insurance Portability Accountability… more
- YAI (Manhattan, NY)
- …turning and/or using lifts, colostomy, ostomy and catheterization. Works with RN, LPN and Health Care Specialist to ensure the medical needs of people supported ... pressure, heart rate) + Scheduling/following up on appointments in coordination with Health Care Specialist and appropriate nursing staff + Performing catheter… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Maintains case logs, prepares records and regular status reports. Interacts with health care providers, often under adverse conditions due to discovery ... investigating and remediating allegations of FWA while adhering to compliance and regulatory requirements. Primary activities include substantiating referrals, case… more
- YAI (NY)
- …assisting with activities of daily living (ADLs) including intimate and personal care , teaching daily and independent living skills, providing individual and group ... the individuals in assigned program(s) , and the overall care and well-being in accordance with YAI guidelines, ensuring...well-being in accordance with YAI guidelines, ensuring safety and health of individuals at all times. DSPs work directly… more