- Zelis (St. Petersburg, FL)
- …clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA ... specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What you'll do: + Perform… more
- Molina Healthcare (Tampa, FL)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... requirements of customers as it pertains to contracting, network management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Audits loaded provider records for… more
- Elevance Health (Tampa, FL)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide specific… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …related updates, strategies, and initiatives to key stakeholders and senior management . + Develop and manage comprehensive budgets for various projects ensuring ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Cardinal Health (Tallahassee, FL)
- …data to insurance providers + Researching and appealing denied and rejected claims + Preparing, reviewing, and transmitting claims using billing software ... and paper claim processing + Following up on unpaid claims within standard billing cycle time frame + Calling...experience as a Medical Biller or within Revenue Cycle Management preferred + Strong knowledge of Microsoft Excel +… more
- Norstella (Tallahassee, FL)
- …offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and EMR data. You will be joining an organization ... accuracy and quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data, to uncover actionable insights and drive… more
- Butterfly Effects (Deerfield Beach, FL)
- …You'll manage assigned accounts, research and resolve denied or underpaid claims , and maintain compliance with payer guidelines and HIPAA regulations. This ... CPT codes, and claim details related to denials or underpayments. + Research claims using insurance portals, Central Reach, and EOBs to determine resolution paths. +… more
- CVS Health (Tallahassee, FL)
- …Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/ Claims Research Medicaid team. Extensive claims research on ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …+ Work with bioanalytical team members on activities related to sample management , pharmacogenomics and biomarker development and provide analysis support related to ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject ... customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority… more