- MyFlorida (Marianna, FL)
- …of the foster care system, as directed by the Director of Pro Bono and Appeals or the Circuit Director. + Responsible for developing in collaboration with the office ... of Pro Bono and Appeals , a continuous flow of qualified, prospective volunteer and...Director, Director of Operations, Office of Pro Bono and Appeals and the Director of Communications. + Will work… more
- Actalent (Miami, FL)
- …+ Review submitted documentation and gather additional information to support the appeals process. + Forward completed cases to pharmacists for final determination. ... Skills + Certified Pharmacy Technician (CPhT). + Experience in pharmacy operations, appeals , managed care, claims processing, and handling denials. + Strong data… more
- Molina Healthcare (Orlando, FL)
- …and independent contracting, down line broker applications commissions, Broker Agent appeals /grievances, educating Brokers on plan benefits in all markets, managing ... the detailed process of broker commission reconciliation * Handles Broker Agent appeals /grievances. * Educates Brokers on plan benefits in all markets. * Makes… more
- Molina Healthcare (St. Petersburg, FL)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Molina Healthcare (Jacksonville, FL)
- …+ Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains Point of Sale claims adjudication, state, NCQA, and CMS ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- AssistRx (Maitland, FL)
- …for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move through the process as ... expedite patient access + Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in coverage to management… more
- HCA Healthcare (Port St. Lucie, FL)
- …and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case management, and utilization review/management. ... staff in the reduction of payer denials and in the denial and appeals process, as requested by the Case Management Department and Patient Accounting Services.… more
- J&J Family of Companies (West Palm Beach, FL)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) + Ability to establish relationships, collaborate, and influence… more
- J&J Family of Companies (Jacksonville, FL)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) + Ability to establish relationships, collaborate, and influence… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible ... for the appropriate use of software and applications and enters case management information accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to patient admission/safe discharge. + Participates in… more