- Monte Nido (Miami, FL)
- …level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals . + Engage in clinical rounds as an active treatment team member ... providing payor feedback and needs for next review, guidance on level of care recommendations, and feedback on what will be needed for authorization of clinically indicated services. + Support treatment team members & Admissions by discussing services covered… more
- Deloitte (Miami, FL)
- …preparation of responses and drafting issue responses as well as more formal appeals . + Preparing business and individual federal and state income and other tax ... returns and forms. + Preparing income tax provisions in accordance with ASC 740 as well as supporting the Deloitte audit team on tax provision reviews, including analyzing the authority level of uncertain tax positions. The successful tax consultant will be… more
- MyFlorida (Miami Beach, FL)
- …programs implemented well by SFAs undergoing review. Assists with administrative appeals on an as-needed basis. Assists with the emergency management functions ... of the bureau during periods of disaster. Performs other related duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: + Ability to understand and apply applicable rules, regulations, policies, and procedures and have extensive knowledge of foods and nutrition.… more
- Elevance Health (Pinellas Park, FL)
- …+ Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a ... minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. + Specific education, years, and type of experience may be required based upon state law and… more
- Elevance Health (Miami, 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. + 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 health)… more
- Intermountain Health (Tallahassee, FL)
- …providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding ... review, audit findings, and appeal strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex… more
- CVS Health (Tallahassee, FL)
- …new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates providers on our self-service ... options; Assists providers with credentialing and re-credentialing issues. -Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits. -Handles extensive file review requests. **Responsibilities** + Answering questions and… more
- TEKsystems (Tampa, FL)
- …and report documentation trends, coding errors, or compliance risks. * Assist with appeals and denials related to coding or medical necessity. * Maintain current ... knowledge of coding updates, payer policies, and compliance regulations affecting ASC services. * Support coding audits and implement feedback from quality reviews. * Monitor and respond to payer coding updates or regulatory changes relevant to ASCs. * Assist… more
- Humana (Tallahassee, FL)
- …revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices and ensure timely, equitable resolution of issues. ... **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + 10 plus years' experience in health insurance operations, complaint management, and CMS STARs programs (experience in large national insurers strongly preferred). + 6 plus… more
- Florida Atlantic University (Boca Raton, FL)
- …+ Independently render admissions decisions, consulting with Admissions/Provost leadership on appeals and further evaluations as needed. + Troubleshoots and resolves ... complex issues related to student information and the integrity of documents. Investigate and report suspected falsified credentials to the Director of Operations. + Attends regular training on using Slate CRM, Banner, and OnBase Document Imaging and… more