- Elevance Health (Tampa, FL)
- …systems within a healthcare payer or RCM organization and associated coding/ claim integrity certifications strongly preferred . + Experience working with ... Medicare/ Medicaid and associated claims return files strongly preferred . + MPH,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Healthfirst (FL)
- …within any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). + Experience with database reporting and automation, ... + Bachelors degreefrom an accredited institution or equivalent work experience. ** Preferred Qualifications:** + Experience working within a Healthcare industry (such… more
- CHS (Clearwater, FL)
- …related to claims and calls and provides feedback to their Manager . + Maintains up-to-date working knowledge on regulatory requirements associated with billing ... **Overview** ** ** ** Claims and Call Auditor (Call Center QC) -...with accuracy, and work with the MPS Call Center Manager /Supervisor/Team Lead and analyze the data for training purposes.… more
- Healthfirst (FL)
- …and track record of success directing the efforts of developers as a project manager or product owner in a deadline-driven and fast-paced environment + Ability to ... High School Diploma or GED from an accredited program ** Preferred Qualifications:** + Bachelor's Degree or higher from an...terms, code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices WE ARE AN EQUAL OPPORTUNITY EMPLOYER.… more
- Molina Healthcare (Miami, FL)
- …thinking. Experience with Medicare/Medicaid, MS 365 and familiarity with claims is highly preferred . The Case Manager must be able to work in a high-volume ... settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) To all current Molina employees: If you are interested… more
- Travelers Insurance Company (Tampa, FL)
- …claim and/or legal experience and technical expertise to evaluate severe and complex claims preferred . + Able to make independent decisions on most assigned ... and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the...facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel… more
- Travelers Insurance Company (Tampa, FL)
- …reserving, negotiating and resolving assigned Construction Defect and Latent Property Damage claims . Provides quality claim handling throughout the claim ... facts or allegations of each case. + Consults with Manager on use of Claim Coverage Counsel...preferred . + Advanced level knowledge and skill in claim and litigation. + Basic working level knowledge and… more
- Molina Healthcare (Miami, FL)
- …execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as ... Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate payment levels, optimize resource utilization,… more
- Molina Healthcare (FL)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis… more
- Molina Healthcare (St. Petersburg, FL)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more