- 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
- American Express (Sunrise, FL)
- …partners to improve customer experience, deliver on business goals and enhance claims and servicing + For external partners, responsible for ensuring all strategic ... and operational deliverables are met + Project management of all critical workstreams to drive project plans forward toward targeted timeframes by ensuring oversight of critical timelines & progress of all activities + Lead identification of operational issues… 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
- CVS Health (Tallahassee, FL)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality. Additional responsibilities to include but not limited to the following: - Responsible… more
- Air National Guard Units (FL)
- …You must provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof ... that you meet the Education requirements for this position. Additional Information If you are a male applicant who was born after 12/31/1959 and are required to register under the Military Selective Service Act, the Defense Authorization Act of 1986 requires… more
- Air National Guard Units (Jacksonville, FL)
- …You must provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof ... that you meet the Education requirements for this position. Additional Information If you are a male applicant who was born after 12/31/1959 and are required to register under the Military Selective Service Act, the Defense Authorization Act of 1986 requires… more
- Publix (Lakeland, FL)
- …statements, country-of-origin labeling, distribution statement requirements and all claims (eg, natural, all-natural, clean label, dairy-free, gluten-free) + ... industry standard knowledge set forth by respected sources including, but not limited to, American Frozen Food Institute (AFFI), American Institute of Baking (AIB), Association of Food and Drug Officials (AFDO), British Retail Consortium (BRC), Consumer Brands… more
- Evolent (Tallahassee, FL)
- …as HIPAA, as well as healthcare systems and domains (FHIR/HL7, EMR/EHR, Claims , Members, Providers, Payors, etc.). + Experience with designing and implementing ... well-thought-out APIs in a service-oriented architecture. + Strong problem-solving, communication, and organizational skills. Ability to work effectively in a team-oriented environment. **To comply with HIPAA security standards (45 CFR sec. 164.308 (a) (3)),… more
- AdventHealth (Tampa, FL)
- …Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient ... care/observation stays and referral services. The Physician Advisor is an important contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies. This individual also serves as the subject matter expert, providing… more