- Zelis (FL)
- …Identify new DRG coding concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client turnaround time, and department ... clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA… more
- Highmark Health (Tallahassee, FL)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- MetLife (Tampa, FL)
- …office for meetings Key Responsibilities: * Effectively manage a team of STD Claim Specialists in a fast-paced environment to ensure individual and team performance ... indicators and delivering on customer commitments through quality and timely claim determinations including compliance with ERISA and other state and regulatory… more
- Sedgwick (Tallahassee, FL)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more
- Molina Healthcare (FL)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and...that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine… more
- AdventHealth (Maitland, FL)
- …information for accurate billing. Processes daily error logs, stalled reports, aging claims , and any ah-hoc reports. Addresses claim issues from insurance ... Produces written correspondence to payers and patients regarding status of claim , requesting additional information, etc. + Initiates next billing, assign… more
- Sedgwick (Tallahassee, FL)
- …& Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims regionally unassisted up to $10M, including having the ability to address ... and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. +… more
- Elevance Health (Tampa, FL)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines… more
- Sedgwick (Orlando, FL)
- …**PRIMARY PURPOSE** **:** To investigate and adjust property and casualty claims , both residential and commercial, with little to no supervision. **ESSENTIAL ... FUNCTIONS and RESPONSIBILITIES** + Inspects claims and contacts involved parties in a timely manner....parties in a timely manner. + Investigates circumstances of claim (s) as required for coverage determination, cause, and compensable… more
- Guidehouse (Tampa, FL)
- …of assigned Medicare and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. ... needed + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific...Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, review… more