- AdventHealth (Maitland, FL)
- …spreadsheets throughout any settlement, mediation, arbitration or lawsuits. + Audit current contracts for potential revenue opportunities and contract violations ... understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and...+ 3 years Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment,… more
- Molina Healthcare (Miami, FL)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more
- Highmark Health (Tallahassee, FL)
- …supervisory direction and oversight for all enrollment, premium billing, claims and/or customer service telephone and written correspondence inquiries (routine, ... training and mentor programs, and assists to provide interview/hiring and audit support when needed. **ESSENTIAL RESPONSIBILITIES** + Supervises the daily operations… more
- Highmark Health (Tallahassee, FL)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Dycom (West Palm Beach, FL)
- …Sustainability Report + Serve as the primary contact for the annual sustainability data audit with external audit firms + Serve as the primary internal liaison ... information and analyze for accuracy + Work with Dycom claims , TPA, broker and insurer to put together, analyze...to put together, analyze and review documents for quarterly claims review + Monitor and analyze monthly and quarterly… more
- Highmark Health (Tallahassee, FL)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Molina Healthcare (St. Petersburg, FL)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior… more
- Banner Health (FL)
- …information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper ... to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials...as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Sarasota, FL)
- …analytical reports, and providing advanced support to QMS users. Support the BH Audit Team with performing Food Safety & Product Quality audits at different venues ... food safety related programs as requested. + Organize and Audit co-manufacturers QA related documents to ensure compliance to...COAs, Allergen forms, Weight & Tare, any other product claims , etc.), as applicable. + Perform Food Safety &… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …Include but not limited to: Solves complex issues regarding travel claims , mileage reimbursement claims , transportation contracts, emergent and non-emergent ... point of contact, and responsible party for the Beneficiary Travel IPERA audit process and documentation. Responsible for comprehensive monitoring of the planning,… more