- MyFlorida (Orlando, FL)
- …but are not limited to: fraud against the Medicaid Program, false claims against the Medicaid program, investigating possible criminal violations of any applicable ... state law pertaining to fraud in the administration of the Medicaid program, investigate allege abuse or neglect of patients, investigate the alleged misappropriation of patients private funds in health care facilities, and safeguarding the privacy rights of… more
- Defense Logistics Agency (Jacksonville, FL)
- …You MUST provide transcripts or other documentation to support your educational claims . Unless otherwise stated: Unofficial transcripts are acceptable at time of ... application. GRADUATE EDUCATION: One academic year of graduate education is considered to be the number of credits hours that your graduate school has determined to represent one academic year of full-time study. Such study may have been performed on a… more
- CVS Health (Tallahassee, FL)
- …routine nature. + Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc + Maintain department ... established performance metrics at a meets or exceeds expectations level + Work together as a team and apply the Aetna Core Values in day-to-day operations + Creating a Differentiated Service Experience + Demonstrating Service Discipline + Handling Service… 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
- Cardinal Health (Tallahassee, FL)
- …patient medical records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise EMRs, the registration process ... and charge entry. + Supports the overall workplan of the Compliance Department. + Other duties as assigned. **_Qualifications_** + 8-12 years of experience, preferred + Bachelor's degree in related field, or equivalent work experience, preferred* Bachelor's… more
- Centene Corporation (Tallahassee, FL)
- …business needs. + **Design and maintain** attribution models based on claims data, member selection, contractual arrangements, and regulatory requirements. + ... **Monitor and improve** attribution accuracy through audits, root cause analysis, and continuous process refinement. + **Lead change management** efforts for attribution logic updates, system enhancements, and policy changes. + **Support strategic… more
- Walgreens (Sarasota, FL)
- …payment rejections. Resolves third party rejection problems promptly, and resubmits rejected claims for payment on a timely basis. + Manages and controls ... Prescription Department inventory. Adheres to Company buying procedures, recommends and orders merchandise from proper internal and external sources. **People and Performance Management** + Supervises pharmacy department team members to assure performance of… more
- Humana (Tallahassee, FL)
- …either the state agency or payer perspective + Detailed understanding of healthcare claims Travel: While this is a remote position, occasional travel to Humana's ... offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range… more
- AssistRx (Maitland, FL)
- …to expedite patient access + Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in coverage to ... management + Act as a liaison for field representatives, health care providers and patients Requirements + In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage + 2 to 3 years of benefit investigation involving the analysis and… more
- Humana (Tallahassee, FL)
- …on beneficiary needs; assists with beneficiary related issues which may include claims inquiries, enrollment issues, travel attestations, access to care, wait lists, ... coordination of services and other non-clinical beneficiary concerns. + Assist in researching and providing community resources when appropriate. Interface with providers as necessary and appropriate for issue follow-up and resolution. Discuss identified… more