- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions as… more
- Humana (Tallahassee, FL)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Duke Energy (Lake Buena Vista, FL)
- …to coordinate field changes, extra work authorizations, material request, etc. with Project Manager + Knowledgeable of labor contracts and able to analyze and adjust ... daily in reaction to emergent work (storms, escalated customer issues, customer claims , outages) and daily crew unavailability + Validates material requirements for… more
- The Robison Group (Pensacola, FL)
- …the position will be expected to perform investigations of workers compensation claims , liability investigations, multi-line insurance claims , criminal and civil ... results (except when undergoing documented medical treatment). + College Degree preferred . TRAINING The Robison Group provides remote and/or in-classroom training to… more
- Utilities Service, LLC (Palm Bay, FL)
- …the crew. + May be delegated the authority to investigate incident reports, damage claims , etc., and to settle minor damage claims . + Maintains accurate records, ... or older + High School Diploma or GED equivalent preferred . + A minimum of 3120 hours of working...for this role, please contact the recruiter or hiring manager . **Individuals with a disability who desire a reasonable… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Homes, and Private Pay statements. KEY RESPONSIBILITIES * Process third-party billing, claim resolution, and adjudication * Manage FFS and PPS billing * Conduct ... weekends as needed * Perform additional duties as assigned by the Billing Manager Qualifications QUALIFICATIONS * High school diploma or equivalent * Minimum of two… more
- Veterans Affairs, Veterans Health Administration (Naples, FL)
- …worker, dietician, clinical pharmacist, behavioral health clinician, and a nurse care manager ) to oversee and coordinate medical care for a population of Veterans ... in spoken and written English in accordance with 38 USC 7402(d). Preferred Experience: Board Certification in Internal Medicine or Family Medicine is highly… more
- Elevance Health (Miami, FL)
- …or documentation is unclear. + Trains and educates others on coding documentation, claim payment guidelines, and related issues. + Reviews CPT and ICD-9 codes ... an equivalent background. + Certified Medical Code (CPC or CCS-P) required. ** Preferred Skills, Capabilities and Experiences** : + Knowledge of medical terminology… more
- Pearle Vision (Jacksonville, FL)
- …Ophthalmic Technician / Medical Office Administrator REPORTS TO: Store General Manager FLSA STATUS: Hourly; Non-Exempt POSITION PURPOSE: The major responsibility of ... for priority patients * Scheduling appointments * Processing insurance claim forms * Patient and insurance billing * Optometric...keeping the office running smoothly * Prior experience is preferred . We will happily train the candidate with an… more
- Elevance Health (Miami, FL)
- … preferred . + Prior "telephonic" Case Management experience with a Managed Care Company preferred + Certification as a Case Manager . + Ability to talk and ... **Telephonic Nurse Case Manager II** **Sign On Bonus: $3000** **Location** :...treatment plans. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires a… more