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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Master of Public Administration (MPA) or Master of Public Health (MPH) degree required; and. A satisfactory equivalent combination of education, training, and minimum 10 years of relevant healthcare industry experience in a provider network management and value-based environment.
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Collaborates with the physicians and interdisciplinary care team regarding expected LOS for specific patients utilizing MCG criteria and Medicare benchmarks. We have an exciting opportunity to join our team as a Case Manager- Part time- RN required.
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In this role, you will be responsible for independent review and evaluation of completed UAS reassessments for appropriateness of long-term care services for consumers, in accordance with Medicare and Medicaid guidelines.
$100 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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EducationHigh school diploma or GED in related fieldExperience Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Licenses and CertificationsCertified Professional Coder Certificate (CPC) or Certified Coding Specialist (CCS)Working Conditions/Physical DemandsRemote based work with rare onsite requirement.
$29.15 - $35RemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF) Responsibilities: Under the direction of the Compliance Officer and Compliance Department management, the Compliance Auditor is responsible for working independently on assigned projects to ensure health plan compliance with Medicare (Part C and D), NYS Medicaid and MLTC regulations.
$77,099.34 - $92,519.21 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience with Medicaid/Medicare systems processing, including Claims, Provider, and Member Eligibility. Key Requirements: Mainframe production control activity experience including job scheduling using Control-M for z/OS and project code promotions using ISPW. Strong experience with TSO/ISPF, JCL, VSAM, CICS, COBOL, and SYNCSORT. Ability to work independently from home while communicating and interacting remotely.
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If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
Starting at $72,032 - $91,381 a yearFull-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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We will include Medicare Advantage plans only as part of this health plan line of business. plus years of Medicare Advantage experience. Epic Clarity Data Model certification in one or more modules (EpicCare Inpatient, Hospital Billing, Prelude ADT, Radiant, Willow, Optime) or to be obtained within days of hire.
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The ideal Candidate will primarily support firm partners and attorneys and be able to assist with client intake, obtaining lien information for ERISA, Medicare, Medicaid, and workers compensation, to include some admin work as needed.
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Company Overview:A distinguished Home Healthcare Agency based in New York with a coveted 5 Star Rating for excellence in Patient Care, as recognized by Medicare & Medicaid Services, who is committed to delivering top-tier services, specializing in skilled nursing, physical therapy, and pharmacy assistance - focusing on aiding seniors in maintaining their independence at home.
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Knowledge and understanding of current Medicare and Medicaid marketing communications and guidelines and be familiar with Maximus. Overview The Marketing Representative role at RiverSpring Health Plans by RiverSpring Living, a world-renowned long-term care organization located in Riverdale - North Bronx, will be responsible for establishing and maintaining successful and robust referral relationships for the health plan’s various lines of business as well as educating eligible consumers about our Medicare and/or Medicaid products.
$95,000 - $105,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Medicare Compliance: Stay informed about Medicare billing regulations and changes in reimbursement policies. Skilled Billing (e.g., Medicare Part A or B): ICD-10 and CPT Coding: Ensure proper ICD-10 diagnosis and CPT procedure coding for Medicare billing.
$50,000 - $70,000 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience within Quality Analytics, HEDIS or Medicare Star Proficiency in any of the following analytics tools: SQL, SAS, Alteryx, R, Python, Tableau, Power BI, CognosKnowledge, Skills and AbilitiesStrong ETL knowledge in a data warehouse ecosystem.
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