- LogixHealth (Dania Beach, FL)
- …A/R (Accounts Receivable) reports to follow up on unpaid claims + Send out appeals on claims that require an appeal + Submit required documentation to insurance ... experience in professional healthcare billing + Familiarity with payer regulations, claims appeals processes, and denial reasons + Proficiency in EHR and billing… more
- Humana (Tallahassee, FL)
- …include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The ... population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers… more
- AdventHealth (Altamonte Springs, FL)
- …and making recommendations on appealed provider claims and makes determinations for appeals and grievances from patients; assists in drafting and submitting clinical ... denial appeals , as needed + Develops Medical Director relationships with payors to have open communication and consistently meets with these individuals to have… more
- AssistRx (Orlando, 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
- AssistRx (Orlando, 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
- Centene Corporation (Tallahassee, FL)
- …optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and ... medical necessity appeals . + Participates in provider network development and new market expansion as appropriate. + Assists in the development and implementation of… more
- MyFlorida (Tallahassee, FL)
- …and offer personalized legal counseling to Department executives on litigation, appeals , legislation, and policy decisions. + Lead Legal Operations: Help manage ... and supervise the Department's legal team, ensuring smooth and efficient operations. Step in as acting General Counsel when needed, leading the team with confidence. + Daily Legal Assistance: Provide daily legal advice and support on issues raised by… more
- CVS Health (Tallahassee, FL)
- …written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . + Ensure all compliance requirements are satisfied and that ... all payments are made following company practices and procedures. + Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. + May provide job shadowing to less experienced staff members. + Utilize all resource… more
- MyFlorida (Tallahassee, FL)
- …appellate briefs and participate in oral arguments, as needed. The litigation and appeals involve the agencies referenced above, as well as other specific agencies ... or cases assigned on an ad hoc basis. + Respond to inquiries from private attorneys, private citizens, etc., regarding the activities and powers of the various agencies assigned. + Maintain current expertise in areas of practice, including reading recent… more
- MyFlorida (Tallahassee, FL)
- …development and implementation of necessary procedures and forms for responding to provider appeals relating to the LIP, DSH, IME, DPP, and GME programs. Review and ... analyze decisions in order to determine the need for revisions to policies and procedures associated with the LIP, DSH, IME, DPP, and GME programs. The incumbent in this position is responsible for preparing special reports and analyses on the LIP, DSH, IME,… more