- Molina Healthcare (FL)
- …and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- Molina Healthcare (FL)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Molina Healthcare (Tampa, FL)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Molina Healthcare (Miami, FL)
- …* At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. * ... and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm… more
- AssistRx (Orlando, FL)
- …that they need. A Day in the Life as a Bilingual Patient Access Specialist : This role works directly with healthcare providers & insurance plans/payers to gather ... provided for a specific pharmaceutical product. The Bilingual Patient Access Specialist will support the healthcare providers addressing questions regarding coding… more
- BayCare Health System (Clearwater, FL)
- …documentation, and medical records. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary ... management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. + Participate in… more
- AssistRx (Maitland, FL)
- …coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
- AssistRx (Maitland, FL)
- …provided for a specific pharmaceutical product. The Insurance Verification Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
- HCA Healthcare (Ocala, FL)
- …Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is valued? If you are… more