- Elevance Health (Miami, FL)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… 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 ... sample, law school transcripts and copy of Florida Bar card: Human Resources Manager Court Administration Judge Lynn N. Silvertooth Judicial Center PO Box 48927… more
- Trinity Health (Fort Lauderdale, FL)
- …Business Service (PBS) centers, including analysis of clinical documentation, assisting in appeals , root cause analysis and tracking as needed. 6. Educates clinical ... level assignment and charge entry. Other related responsibilities as assigned by manager . Minimum Qualifications: + High school diploma or equivalent combination of… more
- Intermountain Health (Tallahassee, FL)
- …management, and designated areas in the response process. 5. Assists manager with interviews, onboarding, monitoring and measuring goals, annual reviews and ... updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7.… more
- Elevance Health (Tampa, FL)
- …alternative surgical and non-surgical treatments. + Performs first level provider appeals of coverage decisions. + Provides support and education to internal ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Prime Therapeutics (Tallahassee, FL)
- …web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with management on regular ... + Clinical and Quality oversight for this program is provided by the Manager , Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors -… more
- Highmark Health (Tallahassee, FL)
- …and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and ... and decisions including but not limited to: physician and member appeals , member or provider information/education. + Participate on cross-functional committees to… more