- CenterWell (Tampa, FL)
- …**Major Duties and Responsibilities** + Oversees day-to-day operations, quality chart audit reviews, recruiting/hiring, team management, and overall ... performance for Care Integration Team associates in the market. + Ensures clinical program integrity at the market level and addresses performance and program improvement opportunities, escalating to Divisional Director as appropriate. + Collaborates with… more
- CenterWell (Daytona Beach, FL)
- …+ Assisting in resolution of inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and ... identifying opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member per Month (PMPM) costs while maintaining high quality care + Optimizing network; preferred… more
- Molina Healthcare (St. Petersburg, FL)
- …Assist with the identification and validation of data sources needed to support RADV audit cycles. + Support the generation of chart retrieval chase lists based ... team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of... activities. This position contributes to the development of chart retrieval chase lists by helping identify and validate… more
- Molina Healthcare (Jacksonville, FL)
- …RADV audit execution by identifying appropriate data sources, validating CMS audit samples, and generating chart retrieval chase lists in coordination with ... contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles… more
- Humana (Tallahassee, FL)
- …health care fraud investigations (Medical Coding or Healthcare (Medical Chart Review/Insurance Billing) or Internal/External Audit or Regulatory/Compliance ... ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and… more
- Molina Healthcare (Miami, FL)
- …validation related activities, including, but not limited to: progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines * Support ... all risk adjustment audit related projects to ensure goals, objectives, milestones and...**Required Experience** 3 Years in coding and medical record chart review and experience with risk adjustment data validation… more
- Elevance Health (Tampa, FL)
- …will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the performance of medical ... audit activities. + Draws on advanced ICD-10 coding expertise,...guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools and auditing workflow systems and reference information… more
- Elevance Health (Tampa, FL)
- …make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical ... audit activities. + Draws on advanced ICD-10 coding expertise,...guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools, auditing workflow systems and reference information to… more
- CenterWell (Tallahassee, FL)
- …+ Analyze EDAPS; report the variances between datahub and eCW. + Conduct Chart reviews to identify educational opportunities. + Perform individual chart research ... identify HEDIS gaps and deficiencies. + Participate in Payer calls/ chart reviews. + Compile payer findings and assist with...collaborative mindset to foster partnership within and the Coding, Audit , and Education department, the PCO, and Humana +… more
- Biomat USA, Inc. (Jacksonville, FL)
- …responsibilities for role (level-specific responsibilities should be included in the chart below):** * Completes weekly review of equipment QC and maintenance ... documentation. * Reviews unexpected plasmapheresis events including electronic donor chart and related documentation pertaining to exceptions occurring during the… more