- Ascension Health (Jacksonville, FL)
- …the time of the offer._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting ... documentation. **Responsibilities:** + Audit specified number of records per coder as defined...records per coder as defined in the system coding audit plan. + Preparesaudit reports that are issued to… more
- University of Florida (Duval County, FL)
- …type: Staff Full-Time Location: Duval Categories: Veteran's Preference Eligible, Legal/ Audit Services/Compliance Department: 27030000 - HA-SELF INSURANCE TRUST FUND ... developing, and updating various databanks, including but not limited to various claims tracking logs containing detailed documentation of a wide variety of content… more
- Sedgwick (Orlando, FL)
- …& Insurance Accounts Payable Associate Sr **PRIMARY PURPOSE OF THE ROLE:** To audit invoices presented for payment and input into data into the accounts payable ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Humana (Tallahassee, FL)
- …operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes ... operational efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify opportunities and… more
- MyFlorida (Lake City, FL)
- …all assigned Contractual Partners including resolving all non-compliance assessments and audit results, documenting all correspondence to the Contractor. Review and ... and make recommendations for further action with respect to contract claims . Coordinates Federal Highway Association (FHWA) approval and field inspections when… more
- Molina Healthcare (Orlando, FL)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- The Cigna Group (Tampa, FL)
- …the requirements of business and reporting teams within areas such as pharmacy claims , medical claims , membership eligibility, etc. Build automated solutions for ... data quality checks, Audit Balance and Controls (ABC), and monitoring processes. Develop data curation pipelines to read data from the enterprise warehouse and… more
- Walgreens (Lakeland, FL)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... companies as well as medical providers and conducts or participates in 3rd party audit . + Assists and supports Store Manager and Pharmacy Manager in analyzing and… more
- CVS Health (Tallahassee, FL)
- …or audit experience. **Preferred Qualifications** + Medicare experience + Claims experience + Experience in reading or researching benefit language in Summary ... Plan Description (SPDs) or Certificate of Coverage (COCs) + Experience in research and analysis of claim processing a plus. **Education** + High School or Equivalent **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range… more
- Air National Guard Units (Jacksonville, FL)
- …takes corrective follow-up action. Verifies quality through the application of audit and investigative methods to ensure compliance with established guidelines. ... you must provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must provide documentation of proof… more