- Elevance Health (FL)
- …a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any ... embassy located in or outside of the US. + A minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * _For Health Solutions and Carelon organizations (including behavioral… more
- AdventHealth (Altamonte Springs, FL)
- …escalation to supervisor/manager if necessary. Processes administrative and medical appeals , refunds, reinstatements, and rejections of insurance claims. + ... Consistently communications with team members to foster a collaborative atmosphere and engages with supervisor/manager on any potential educational opportunities, providing updates on assigned projects. Attends required scheduled meetings, events, and… more
- AdventHealth (Maitland, FL)
- …escalation to Supervisor/Manager if necessary. + Processes administrative and Medical appeals , refunds, reinstatements and rejections of insurance claims with the ... oversight of the Supervisor and/or Manager Qualifications **EDUCATION AND EXPERIENCE REQUIRED:** One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management… more
- University of Miami (Coral Gables, FL)
- …Retired Faculty. + Assists the Vice Provost in managing salary review and appeals . + Reviews and process Coral Gables and Rosenstiel Schools requests for courtesy ... appointments, including International Scholar/Exchange Visitors (form DS-2019). + Reviews and processes faculty secondary appointments for Provost/Vice Provost signature, for all campuses. + Coordinates the 9/12-month payroll option. + Coordinates with the UM… more
- Option Care Health (Tallahassee, FL)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are… more
- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a… more
- Highmark Health (Tallahassee, FL)
- …internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides technical assistance in ... researching and resolving inquiries. **ESSENTIAL RESPONSIBILITIES** + Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. + Resolves claim edits, reviews history records and… more
- Jabil (St. Petersburg, FL)
- …drafting of discovery responses ), motion practice, trial preparation, trials and appeals . + Thinking creatively and providing daily tactical counsel and innovative ... legal solutions to challenging issues facing Jabil's global business units in an expedited manner. + Leading and supporting internal investigations and collaborating with other functions to improve Jabil's investigation processes. + Responsibility for… more
- BrightStar Care (Naples, FL)
- …. Responsibilities include weekly processing of billing and payroll.. Managing Authorizations , appeals and re- submission of claims . Posting cash etc. Must be ... detail oriented and organized . Ability to work in a fast paced environment and can focus with distractions. What We Offer: At BrightStar Care we value each of our employees and care about their wellbeing. We strive to provide best-in-class benefits packages,… more
- Evolent (Tallahassee, FL)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a… more