Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees — including nurses, rehabilitation therapists, social workers, dieticians, other allied professionals, and paraprofessionals — deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 35,000 patients, helping them to live the best lives possible.
Audits functions of VNS CHOICE claims. Collaborates with other Health plan departments to ensure claims are processed in accordance with established guideline and/or policies and procedures. Assists in compliance reviews of internal and Third Party Administrator’s (“TPA”) claims processing policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems. Works under general supervision.
Education: Bachelor’s degree or the equivalent combination of education and experience required.
Experience: Minimum of 3 years related claims and/or auditing experience required. Experience working in a TPA or HMO or managed care environment preferred. Knowledge of Medicare and Medicaid claims required. Prior training and knowledge of DRG, ICD9 and CPT4 required. Proficient PC skills, including Microsoft Windows required. Knowledge of HIPAA guidelines required.