Jobs
>
New York City

    Claims Compliance Remediation Analyst - New York, United States - NYC Health Hospitals

    NYC Health Hospitals
    NYC Health Hospitals New York, United States

    3 weeks ago

    Default job background
    Description

    MetroPlusHealth 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. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

    Position Overview

    The Claims Compliance Remediation Analyst will support the Director of Claims Support to ensure claims rules, guidelines, documents, policies and procedures, reporting, job aides, training, and other key components are compliant with CMS and NYSDOH regulatory entities and maintained within a central repository. This incumbent will partner with the Office of Corporate Compliance to ensure that the Claims Department fully supports company objectives and requirements. The incumbent will also coordinate efforts with the Office of Corporate Compliance and represent the interest of the Claims Department before, during, and after regulatory audits (internal and external).This role is critical to the Claims Department by ensuring documents, workflows, and processes are up-to-date and compliant, reducing incorrect claims payments as well as reducing claim adjustment requests, thereby reducing both medical and administrative expenses.

    Job Description

    • Support the Director of Claims Support to ensure claims rules, guidelines, documents, policies and procedures, reporting, job aides, training, and other key components are compliant with CMS and NYSDOH regulatory entities and maintain within a central repository.
    • Partner with the Office of Corporate Compliance to ensure that the Claims Department fully supports company objectives and requirements.
    • Coordinate efforts with the Office of Corporate Compliance and represents the interest of the Claims Department before, during, and after regulatory audits (internal and external).
    • Ensure documents, workflows, and processes are up-to-date, reviewed annually, and remain compliant, reducing incorrect claims payment as well as reducing claim adjustment requests.
    • Work with the Office of Corporate Compliance, Claims Department, and regulatory entities to facilitate processing of regulatory requests, and escalating performance issues to Claims Department management.
    • Work in collaboration with the Claims training unit to ensure compliance with regulatory requirements.
    • Support corporate training on claims module creation and roll out.
    • Consolidate significant events (regulations, statues, case law, and other development(s)) for regular reporting to the Claims Department via a "Claims Compliance Newsletter".
    • Coordinate the support for business areas in creating, updating, and monitoring metrics to assess continued compliance with regulatory requirements.
    • Coordinate timely responses of claims corrective action plans and execution of remediation plans.
    • Oversee other projects as needed.
    Minimum Qualifications
    • Bachelor's degree required
    • 3-5 years' health plan compliance/regulatory experience
    • 1+ year of medical coding experience, with demonstrated knowledge in sustained coding quality
    • Strong familiarity with CMS and NYS audit protocol
    • Experience in managed care, Medicare and federal regulations, quality improvement, and compliance oversight
    • Experience driving corrective action plans (CAPs) and execution of remediation steps
    • Intermediate to advanced knowledge of CPT/HCPCS/Revenue Code, procedure coding, ICD10 coding, principles and practices, coding/classification systems appropriate for inpatient, outpatient, HCC, CRG and DRG
    • Ability to research authoritative citations related to coding, compliance, and additional reporting needs.
    • Demonstrates overall knowledge of claims processing for various insurances, both private and government
    • Ability to compile high level presentations
    • Solid understanding of health insurance law as it relates to compliance
    Professional Competencies
    • Excellent communication skills both verbal and written
    • Integrity and Trust
    • Customer Focus
    • Functional/Technical skills
    • Ability to work independently or in a team setting, while handling multiple projects and adjusting to changes quickly and meet deadlines
    #LI-Hybrid
  • Crowell & Moring

    Trade Remedies Analyst

    1 week ago

    Crowell & Moring New York, United States

    Job Description · Job DescriptionJob Description · Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia that represents clients in litigation and arbitration, regulatory and policy, and transactional and corporate matters. Th ...

  • Crowell & Moring

    Trade Remedies Analyst

    2 weeks ago

    Crowell & Moring New York, United States

    Company Description · Job Description · Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia that represents clients in litigation and arbitration, regulatory and policy, and transactional and corporate matters. The firm is ...

  • Crowell & Moring

    Trade Remedies Analyst

    1 week ago

    Crowell & Moring New York, United States

    Job Description · Ready to apply Before you do, make sure to read all the details pertaining to this job in the description below. Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia that represents clients in litigation an ...

  • MetroPlusHealth

    Claims Compliance Remediation Analyst

    1 week ago

    MetroPlusHealth New York City, United States

    Empower. Unite. Care. · MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what y ...

  • MetroPlusHealth

    Claims Compliance Remediation Analyst

    1 week ago

    MetroPlusHealth New York, United States

    Job Description · Job DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come ...

  • MetroPlusHealth

    Claims Compliance Remediation Analyst

    1 week ago

    MetroPlusHealth New York, United States

    Job DescriptionJob DescriptionEmpower. Unite. Care. · MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can com ...

  • Citigroup Inc.

    Customer Remediation Lead Analyst

    3 weeks ago

    Citigroup Inc. New York, United States

    The Data/Information Mgt Analyst is a strategic professional who stays abreast of developments within own field and contributes to directional strategy by considering their application in own job and the business. Recognized technical authority for an area within the business. Re ...

  • Tandym Group

    Claims Compliance Remediation Claims Analyst

    3 weeks ago

    Tandym Group New York, United States

    A healthcare company in New York City is looking to add a new Claims Compliance Remediation Analyst to their growing team. In this role, the Claims Compliance Remediation Analyst will be responsible for supporting the Director of Claims Support to ensure claims rules, guidelines, ...

  • MetroPlus Health Plan

    Claims Compliance Remediation Analyst

    3 weeks ago

    MetroPlus Health Plan Brooklyn, United States

    Claims Compliance Remediation Analyst · Job Ref: 93929 · Category: Claims · Department: CLAIMS · Location: 50 Water Street, 7th Floor, · New York, · NY 10004 · Job Type: Regular · Employment Type: Full-Time · Hire In Rate: $81,000.00 · Salary Range: $81, $91,000.00 · Em ...

  • NYC Careers

    Business Program Analyst

    1 week ago

    NYC Careers Manhattan, United States

    **BUSINESS PROGRAM ANALYST**: · - Apply**BUSINESS PROGRAM ANALYST**: · - Agency: HRA/DEPT OF SOCIAL SERVICES · - Posted on: 05/22/2024- Job type: Full-time · Location · MANHATTAN · - Title Classification: Exam may be required · Department · Office Of HR Solutions-NM · - Salary ra ...

  • NYC Careers

    Cyber Security Analyst, Level Ii

    2 weeks ago

    NYC Careers New York, United States

    **Cyber Security Analyst, Level II**: · - Apply**Cyber Security Analyst, Level II**: · - Agency: POLICE DEPARTMENT · - Posted on: 05/14/2024- Job type: Full-time · Location · NYC-ALL BOROS · - Title Classification: Exam may be required · Department · INFO TECHNOLOGY BUREAU/CV · - ...

  • McCarter & English

    Information Security Analyst

    2 weeks ago

    McCarter & English Newark, United States

    The Information Security Analyst is a vital support role within the firm, reporting to the Information Security Governance Manager to support the firm's information security framework. This hands-on position involves contributing to the maintenance and enhancement of the firm's i ...

  • GreenPoint Technologies

    Information Security Analyst

    3 weeks ago

    GreenPoint Technologies Newark, United States

    **Information Security Analyst** · Newark · The Information Security Analyst is a vital support role within the firm, reporting to the Information Security Governance Manager to support the firm's information security framework. This hands-on position involves contributing to the ...

  • EmployVision

    Incident Response Analyst

    2 weeks ago

    EmployVision New York, United States

    **Incident Response Analyst (CSIRT Consultant)** · **Hybrid in NYC 10019** · CSIRT Consultant role will be responsible for responding and managing end-to-end Security Incident Management Lifecycle: Incident Identification, Triage, Containment, Eradication, Recovery and Lesson Lea ...

  • Lambda

    Security Grc Analyst

    1 week ago

    Lambda New York, United States

    Lambda's GPU cloud is used by deep learning engineers at Stanford, Berkeley, and Carnegie Mellon. Lambda's on-prem systems power research and engineering at Intel, Microsoft, Kaiser Permanente, major universities, and the Department of Defense. · If you'd like to build the world' ...

  • Lambda

    Security Grc Analyst

    3 weeks ago

    Lambda New York, United States

    Lambda's GPU cloud is used by deep learning engineers at Stanford, Berkeley, and Carnegie Mellon. Lambda's on-prem systems power research and engineering at Intel, Microsoft, Kaiser Permanente, major universities, and the Department of Defense. · If you'd like to build the world' ...

  • Rutgers University

    Administrative Analyst Iii

    1 week ago

    Rutgers University Newark, United States

    **Position Details**: · - Position Information**Recruitment/Posting Title** · - Administrative Analyst III**Job Category** · - Staff & Executive - Healthcare - Administrative Services**Department** · - NJMS-Office of Education**Overview** · - New Jersey's academic health center, ...

  • NYC Careers

    Network Analyst

    2 weeks ago

    NYC Careers Manhattan, United States

    **Network Analyst - Information Systems**: · - Apply**Network Analyst - Information Systems**: · - Agency: OFFICE OF MANAGEMENT & BUDGET · - Posted on: 04/17/2024- Job type: Full-time · Location · MANHATTAN · - Title Classification: No exam required · Department · Capital and MGM ...

  • Columbia University

    Revenue Integrity Analyst

    3 weeks ago

    Columbia University New York, United States

    Job Type: Officer of Administration · - Bargaining Unit: · - Regular/Temporary: Regular · - End Date if Temporary: · - Hours Per Week: 35 · - Standard Work Schedule: · - Building: · - Salary Range: 65,000-85,000 · - The salary of the finalist selected for this role will be set ba ...

  • Apple Bank for Savings

    Security Operations Center

    1 week ago

    Apple Bank for Savings New York, United States

    Hybrid/New York, NY · Pay Range: $80,000 - $100,000 · The Security Operations Center (SOC) Analyst, AT will work closely with Apple Bank's Managed Security Service Provider (MSSP). The success criteria of this role is contingent upon the Analyst's expertise in SIEM event correlat ...