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Trains each state's provider dispute resolution unit on CMS standards and requirements, including the proper use of the Molina Provider Grievance and appeals system. Reviews and analyzes collective grievance and appeals data along with audit results on unit's performance; analyzes and interprets trends and prepares reports that identify root causes of member dissatisfaction; recommends and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare's maximum STAR ratings.
$189,732.18 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Build strong/collaborative relationships with upstream and downstream departments, including Provider Network Operations, to ensure timely resolution of provider inquiries and prevent escalation to DOH/DFS or other regulatory bodies.
$170,000 a yearFull-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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We are a major provider of health and wellness services, senior and children’s care, addiction recovery services, as well as affordable housing and support. Working knowledge of funding source requirements for Affordable Supportive Housing including OMH, DOH, NY1515, HPD, HCR.
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In-depth knowledge of all Fidelis Care products, including “metal” products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory.
$38.07 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Care Consultant Sr. for Provider Success is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business) to assess and deploy appropriate interventions to drive success in value-based care.
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Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception.
$63,079Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience in Provider Data Analytics, Provider Relations, Network Development, or Contract Review. Assist the Provider Network Analyst and Director of Plan Network Operations to evaluate, create, and refine Standard Operating Procedures (SOPs) that support cross-functional departmental integration and ensure compliance with CMS standards.
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Who we are: ServiceMaster by Complete is a trusted provider of water damage restoration, fire and smoke damage restoration, mold remediation, and various disaster restoration and cleaning services.
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Working knowledge of claims processing, correspondence and CRM platforms and adjudication strategies Demonstrated Experience with claims testing/auditing/QA Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
$170,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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At least five (5) years of analytics development experience for a health provider, health plan or accountable care organization including:Experience working in a health plan and/or Health Delivery System focused on medical economicsExperience working in healthcare provider analytics related to managed care contracting, population management, clinical or financial decision supportStrong data mining skills using tools like SQL, R, Python, SAS, etc.
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INVENTORY CONTROL ART HANDLER, Long Island City UOVO is the nation's leading storage and logistics provider for art, archives, and collectibles with state-of-the-art facilities in New York, Delaware, Florida, California, Colorado, and Texas.
$27Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Using all internal X-ray and care coordination software in order to properly document and communicate X-ray studies performed between the provider, Aftercare and radiologists reading the X-rays.
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Must practice within the scope of the New York State Education law AND be under the supervision of a licensed practitioner in that profession who must be enrolled as a Medicaid provider Experience Required: Minimum of one year working with the medically fragile population AND Minimum of one year of clinical experience with pediatric population Preferred: involving end-of-life care.
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About Agency MedPro Healthcare Staffing is a Joint Commission certified provider of contract staffing services. Key Words: CT Technologist, CAT Scan Tech, Computerized Axial Tomography, CT Tech *Weekly payment estimates are intended for informational purposes only and include a gross estimate of hourly wages and reimbursements for meal, incidental, and housing expenses.
$2,733 a weekExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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EXL Risk Control is a leading provider of risk assessments and loss control surveys to commercial lines insurance carriers. You will assess the risk for various commercial insurance lines of business that can include Property, General Liability, Workers Compensation, Auto/Fleet, Products Liability, Inland Marine and Builders Risk. Tools or Items You Must Provide:·Windows-based PC with an image/document scanner·Digital camera·High speed internet access·Measuring device such as: laser, 100 ft.
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provider job in Bronx, NY
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