- MyFlorida (Tallahassee, FL)
- …the community and citizens of Florida, including in areas of criminal appeals , civil litigation, consumer protection, Medicaid fraud, and victims and civil rights. ... We invite you to visit our website at www.myfloridalegal.com to learn more about the State of Florida's law firm and its many opportunities. Salary and Benefits: $44,028.79 Annually / $1,693.41 Biweekly Working for the State of Florida is more than a paycheck.… more
- University of Miami (North Miami, FL)
- …and insurance authorizations including pre-authorization and retro-authorization and appeals as needed. + Schedules patient appointments, adds/removes/edit ... appointment slots, and edits appointment notes + Assists with clinic closures and reschedules by contacting patients and rescheduling appointments + Answers patient questions regarding surgery, post-operative recovery, and rehabilitation protocols +… more
- University of Miami (North Miami, FL)
- …billing, and insurance authorizations including pre-authorization and retro-authorization and appeals as needed. Assists with scheduling patient appointments and ... clinic closures and reschedules by contacting patients and rescheduling appointments. + Answers patient questions regarding outpatient procedures, post-operative recovery, and rehabilitation protocols. + Serves as a Preceptor, mentor, and/or supervisor for… more
- Elevance Health (Miami, FL)
- …for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to identify ... adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers regarding coding and fee schedule updates. **Minimum Requirements:** Requires a BA/BS degree and a minimum of 2 years related experience; or any… more
- Evolent (Tallahassee, FL)
- …(NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals . + Ensures documentation of all communications with medical office staff ... and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall… more
- Cardinal Health (Tallahassee, FL)
- …industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint, ... Teams, Outlook, and Excel + Excellent observation skills to easily identify trends and problems while providing solutions + Superior written & verbal communication skills + Required to effectively present information in a one-on-one and small group situations… 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
- CVS Health (Tallahassee, FL)
- …new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and ... contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. + Work hours will be… more
- MyFlorida (Sarasota, FL)
- …position requires research and reviews are in areas of law including appeals from county court (both civil and criminal), complex civil litigation, constitutional ... questions, complex family law cases and criminal matters, including post-conviction motions and related civil matters such as petitions for extraordinary relief filed by or on behalf of sentenced inmates, pretrial detainees and other litigants. Examples of… more
- City of Jacksonville (Jacksonville, FL)
- …of General Counsel (OGC) in hearings and at various internal board hearings and appeals . + Attends meetings of the City Council, boards, agencies and OGC clients. + ... Performs other duties as assigned. Knowledge, Skills and Abilities + Ability to gain knowledge of City Ordinances and Charter provisions relating to the authority and functions of Consolidated Government, established precedents and sources of legal reference… more