- J&J Family of Companies (Jacksonville, FL)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims , and appeals/grievances); REMs certification; Medicare and Medicaid rules ... administration and monitoring. + Educate staff on payer requirements, coding, billing, claim submission, and acquisition. + Share TC insights with coalition members… more
- Elevance Health (Lake Mary, FL)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... create predictive impact decision making tools + Recommends policy changes and claim 's system changes to pursue cost savings. + Reviews results post-implementation… more
- Robert Half Office Team (Boca Raton, FL)
- …Order placement -high volume multi-line and bulk ordering * Research, validate and process claim requests, * Act with an appropriate sense of urgency to resolve and ... Leads with Sales in accordance with established criteria. Requirements Requirements: * Claims processing or related "processing" experience. * At least 2 years… more
- Highmark Health (Tallahassee, FL)
- …with AHN or other community providers and providing assistance with resolving claim or billing issues.Educate members about access to comprehensiveclinical care and ... department (including but not limited to Product Management, membership, claims , eMarketing, etc.). Identify any opportunities for process improvements.Success will… more
- CVS Health (Tallahassee, FL)
- …met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or ... state of Florida. **Preferred Qualifications** + Provider Data Management + Claim and/or Customer Service Experience **Education** + Bachelor's Degree or equivalent… more
- HUB International (Davie, FL)
- …interpretation and experience-based judgment to resolve except when an established claim servicing protocol exists + Manages, organizes, and conducts client meetings ... including stewardship reports, delivery of risk control services, carrier meetings, claims reviews, preparation of coverage outlines, and marketing of emergent and… more
- University of Miami (Medley, FL)
- …completed batches to appropriate billing offices daily. + Follows up on claims submitted routinely to monitor payment status. + Transmits coded patient treatment ... demographic information, guarantor and insurance information, place of service, referrals, claim info record, and managed care authorization requirements. + Runs… more
- Evolent (Tallahassee, FL)
- …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key ... credentials with Group Health track **(Preferred)** + Familiarity with healthcare claim processing **(Preferred)** + 5+ years experience at payer or management… more
- Kubicki Draper (Jacksonville, FL)
- …have 2+ years of experience. This role focuses on handling claims before litigation, conducting thorough investigations, developing evidence, responding to demands, ... supportive team. Responsibilities + Conduct initial client consultations and evaluate claim viability + Review medical records, insurance policies, photographs, and… more
- AdventHealth (Maitland, FL)
- …accounts discharged but not final billed and ensure we are billing clean claims . The APC Coordinator will assist in overseeing the outpatient coding queues, ... and/or director. + Reviews and resolves accounts in work queues, including claim edits, Discharged Not Billed (DNB) edits, combined accounts, and simple visit… more