- TEKsystems (Tampa, FL)
- …denied for the same reason (vertical audit) 2. Rebilling - focus on "out the door" claim appeals that are more ready to go - have already been vetted. take this time ... phone to communicate and solve problems - determine why claims are denied - determine where to send appeals...determine where to send appeals - determine whether a claim needs to be escalated High degree of ownership… more
- US Air Force - Agency Wide (Patrick AFB, FL)
- …expert advice, and guidance that defines the Center's IT operations , infrastructure, application development, application modernization, network security, high ... and integrated IT hardware, software, and data management solutions to operations across the enterprise, preserving the long-term digital strategy. Builds strategic… more
- MyFlorida (Tallahassee, FL)
- …and job aids. + Investigates and responds to reemployment assistance (RA) claim notices, information requests, and wage audits; participates in RA appeal hearings ... Reemployment Tax Reimbursement Invoices for payment; and identifies and reports incorrect claims and potential fraud. + Coordinates and prepares fitness for duty and… more
- Adecco US, Inc. (Orlando, FL)
- …the FRM provides expert guidance on benefit investigations, prior authorizations, claims resolution, and appeals. This client- and customer-facing role requires ... high-impact reimbursement cases by overseeing benefit investigations, prior authorizations, claims escalations, and appeals, ensuring timely patient access. 3.… more
- Zelis (St. Petersburg, FL)
- …of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the DRG product. The Manager, DRG Validation will be ... you'll do: + Oversee the DRG validation process including management of claim assignment and queues, adherence to client turnaround time and department procedures… more
- UNUM (Tallahassee, FL)
- …Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The ... services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal workflow standards as set forth in the Benefits… more
- Centene Corporation (Orlando, FL)
- …managed care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations . Project ... to external provider related issues + Investigate, resolve and communicate provider claim issues and changes + Initiate data entry of provider-related demographic… more
- CVS Health (Tallahassee, FL)
- …+ 2+ years of International Vendor management experience + 2+ years of Operations Management ( Claim , Customer Service) + Must possess a successful track ... supports the international network, medical cost management, and overall claim /customer service experience. The candidate will provide concierge-level service to… more
- Intermountain Health (Tallahassee, FL)
- …Essential Functions* Oversees the day-to-day revenue cycle functions including claims processing, denials, payments,customer service, and follow up on accounts. ... Assigns daily work schedules. Acts as a resource in the daily operations and activitiesof the department. Performs staff level duties as required.* Develops,… more
- AdventHealth (Apopka, FL)
- …access and adherence, prepares medications for pharmacist review/check, performs claim adjudication and processes customer (patient) account reconciliation. **The ... one of the following: o Rx Plus and Expedien Rx Specialty distributive pharmacy operations o Expedien Rx Non-Specialty distributive pharmacy operations o Rx Plus… more