Current jobs related to Claims Compliance Remediation Analyst - New York - MetroPlusHealth
-
Claims Compliance Remediation Analyst
2 months ago
New York, United States Tandym Group Full timeA 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, documents, policies and procedures, reporting, job aides, training, and other...
-
Claims Compliance Remediation Analyst
2 months ago
New York, United States Tandym Group Full timeA 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, documents, policies and procedures, reporting, job aides, training, and other...
-
Claims Compliance Remediation Analyst
3 weeks ago
new york city, United States Tandym Group Full timeA 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, documents, policies and procedures, reporting, job aides, training, and other...
-
Claims Compliance Remediation Analyst
4 weeks ago
new york city, United States Tandym Group Full timeA 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, documents, policies and procedures, reporting, job aides, training, and other...
-
Claims Quality Assurance Analyst
13 hours ago
New York, United States Hiscox USA Full timeJob Type: Permanent Build a brilliant future with Hiscox We are a fun, innovative and growing Claims Operations team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. This role is a crucial component of delivering successful Quality, continuous improvement and helping to shape...
-
Claims Quality Assurance Analyst
1 day ago
New York, United States Hiscox USA Full timeJob Type: Permanent Build a brilliant future with Hiscox We are a fun, innovative and growing Claims Operations team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. This role is a crucial component of delivering successful Quality, continuous improvement and helping to shape...
-
Claims Quality Assurance Specialist
2 days ago
New York, New York, United States Hiscox USA Full timeAbout the RoleWe are seeking a highly skilled Claims Quality Assurance Analyst to join our US Claims Compliance and Quality Assurance team at Hiscox USA. As a key member of our team, you will play a crucial role in ensuring the quality and integrity of our claims handling processes.Key ResponsibilitiesConduct regular quality reviews of claim files to ensure...
-
Claims Quality Director
1 week ago
New York, New York, United States Tandym Group Full timeDirector of Claims Quality Job DescriptionTandym Group is seeking an experienced professional to lead our Claims Quality Assurance and Performance oversight program.Key Responsibilities:Manage provider reimbursement and analytics, claims quality analysts, claims compliance, training, and remediation, and user acceptance testing (UAT).Oversee staffing and...
-
Claims Quality Assurance Analyst
3 months ago
New York, United States The Ladders Full timeJob Type: Permanent Build a brilliant future with Hiscox We are a fun, innovative and growing Claims Operations team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. This role is a crucial component of delivering successful Quality, continuous improvement and helping to shape...
-
IT Compliance Analyst
3 weeks ago
New York, New York, United States Shulman Fleming & Partners Full timePosition OverviewIT Compliance AnalystLocation: New York City - Hybrid Work ModelRole Summary:The IT Compliance Analyst plays a crucial role in ensuring adherence to the Sarbanes-Oxley Act (SOX) regulations, specifically focusing on IT general controls and pertinent application controls.Key Responsibilities:Ensure compliance with SOX regulations related to...
-
Director of Claims Quality
3 months ago
New York, United States Tandym Group Full timeA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight...
-
Director of Claims Quality
2 months ago
New York, United States Tandym Group Full timeA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight...
-
Director of Claims Quality
3 days ago
New York, United States Tandym Group Full timeA health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight...
-
Director of Claims Quality
4 months ago
New York, United States Momentum Resource Solutions Full timeJob DescriptionJob DescriptionOur client, an insurance provider, is searching for a Director of Claims Quality. This is a permanent role where employees are required onsite 2 days per week. The full job description is as follows: Location: NYC (2 days per week onsite)Job Type: permanent About the role:The Director of Claims Quality has responsibility for...
-
Director of Claims Quality and Excellence
2 weeks ago
New York, New York, United States Tandym Group Full timeAbout the Role:The Tandym Group is seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery, and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance oversight program to ensure payment...
-
Senior Compliance Analyst
4 weeks ago
New York, New York, United States Qualitative Financials Full timePosition- Compliance Reporting - Business Support Location - NY, USA - Day 1 Onsite Duration- Long term Job Overview Senior Compliance Analyst - ISO Standards Over 10 years of experience in the Insurance sector, ideally within Property & Casualty (P&C) Insurance. Proficient in insurance policy and claims management systems. Required expertise in US...
-
Director of Claims Quality and Analytics
5 days ago
New York, New York, United States RCM Health Care Services Full timeJob Title: Director of Claims Quality and AnalyticsWe are seeking a highly skilled and experienced Director of Claims Quality and Analytics to join our team at RCM Health Care Services. As a key member of our leadership team, you will be responsible for driving the creation, delivery, and ongoing facilitation of a data-driven Claims Quality Assurance and...
-
Data Analyst
2 weeks ago
New York, New York, United States Pyramid Consulting, Inc Full timeJob SummaryWe are seeking a highly skilled Data Analyst to join our team at Pyramid Consulting, Inc. as a Risk Remediation Specialist. This is a contract opportunity with long-term potential, and we are looking for a talented individual to tackle a set of analyses and documentation gaps to remediate varied risks on Commercial risk rating models.Key...
-
Regional Claims Analyst
3 days ago
New York, New York, United States Brinks Full timeJob Title: Regional Claims AnalystWe are seeking a highly skilled Regional Claims Analyst to join our team at Brink's. As a Regional Claims Analyst, you will be responsible for investigating reconciliation discrepancies to reduce claim settlements and increase customer satisfaction.Key Responsibilities:Monitor case and claim data for branches in your region...
-
Regional Claims Analyst
1 week ago
New York, New York, United States Brinks Full timeJob Title: Regional Claims AnalystBrink's is seeking a highly skilled Regional Claims Analyst to join our team. As a Regional Claims Analyst, you will be responsible for investigating reconciliation discrepancies to reduce claim settlements and increase customer satisfaction.Key Responsibilities:Monitor case and claim data for branches in your regionDrive...
Claims Compliance Remediation Analyst
3 months ago
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 you do every day.
About NYC Health + HospitalsMetroPlusHealth 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.
- 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
