- Community Health Systems (Naples, FL)
- The ** System Director of Risk Management** is a key leader responsible for overseeing risk management, patient safety, and regulatory compliance across Physicians ... Regional Healthcare System . This role ensures compliance with federal, state, and...incident reporting and medication variance tracking through computerized risk systems . + Monitor trends, identify safety issues, and conduct… 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...by adhering to quality standards. + Utilizes diary management system to ensure that all claims are… more
- Travelers Insurance Company (Orlando, 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...for adherence to quality standards. + Utilizes diary management system to ensure that all claims are… more
- Molina Healthcare (Miami, FL)
- … System Migrations **Preferred Experience** 6 - 8 years working in a claims processing system . Health care environment experience. To all current Molina ... leadership and direction to MMS Operational Units management staff (eg, Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider… 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
- Molina Healthcare (St. Petersburg, FL)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen. Experience ... Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination… more
- CDM Smith (Fort Myers, FL)
- …Assist the project team in developing and maintaining a project risk register. Claim management: Early support for claims and disputes on the project. ... to those requirements. Ensure that proper documentation is developed and maintained for claims . **Job Title:** Commercial Manager - Pacific **Group:** CCI ESS… more
- AdventHealth (Maitland, FL)
- …it relates to reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, ... relates to reimbursement methodologies + Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT,… more