- Molina Healthcare (Jacksonville, FL)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of SQL ... 2005/2008 SSRS report development + Familiar with relational database concepts, and SDLC concepts **Preferred Education** Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. **Preferred Experience** 3 - 5 years… more
- Molina Healthcare (St. Petersburg, FL)
- …supervised learning and rule-based logic to detect potentially incorrectly paid claims . + Contribute to improve data quality, perform data audits, identify ... discrepancies and resolve issues. + Support the identification of opportunities for operational improvement or growth based on analytical findings. + Areas of exposure may include: + Economics/Finance + Data Analysis / Science + Fraud, Waste, and Abuse… more
- Mass Markets (FL)
- …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, ... Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse… more
- Molina Healthcare (FL)
- …care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) * Advanced understanding on health care financial ... terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Molina Healthcare (Jacksonville, FL)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Lake Erie College of Osteopathic Medicine (Defuniak Springs, FL)
- …responsibility for protocols that will aid patients in the reimbursement of insurance claims ; + Assist in the recruitment, interviewing, and hiring of faculty and ... other staff; + Conduct training sessions, in conjunction with the patient care coordinator supervisor, to instruct faculty and other staff; + Help in the development of marketing strategies relating to the recruitment of clinical patients; + Maintain… more
- Philadelphia Insurance Companies (Lake Mary, FL)
- …the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an ... Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life… more
- MyFlorida (Tallahassee, FL)
- …reimbursement methodologies, and relevant laws to find suspicious patterns in claims data and other sources. Perform manual authentications for FRS Online ... users including Legal Representatives, secure individuals and members who cannot access FRS Online after being assisted by a Contact Center representative. Organizes data and prepares a written summary of investigative steps, conclusions, and recommendations… more
- AmeriHealth Caritas (Miami, FL)
- …and report compliance issues. + Maintain knowledge of Facets or other claims systems and relay contract corrections. + Communicate effectively and professionally ... with all parties. + Collaborate with departments to execute AmeriHealth and Plan strategies. + Perform administrative duties and attend required training sessions. + Stay updated on AmeriHealth, Plan regulations, policies, and procedures. **Education &… more
- Cardinal Health (Tallahassee, FL)
- …the interpretation and application of relevant laws (eg, Anti-Kickback, False Claims Act, HIPAA, Antitrust) + Demonstrate excellent communication skills and ability ... to provide business clients with clear and precise guidance on business, compliance, and legal risks + Develop and conduct legal training for business clients + Understand complex legal, compliance and business situations and discern relevant facts and… more
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