- Molina Healthcare (Miami, FL)
- …organized and analytical thinking. Experience with Medicare/Medicaid, MS 365 and familiarity with claims is highly preferred. The Case Manager must be able to ... health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) To all current Molina employees: If you are… more
- Healthfirst (FL)
- …and track record of success directing the efforts of developers as a project manager or product owner in a deadline-driven and fast-paced environment + Ability to ... contract reimbursement terms, code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and… more
- ABM Industries (Clearwater, FL)
- …and coordinates bus evacuation activities as appropriate * Immediately reports any incidents or claims to Operations Manager or Shift Lead * Refuel and maintain ... shuttle equipment and fuel use logs * Maintain a clean work environment, disinfecting shuttle after each use * Performs pre-inspection and post-inspection activities to ensure proper operating conditions, adherence to prescribed Department of Transportation… more
- Kemper (Lake Mary, FL)
- …internal and external training programs to advance knowledge in the area of insurance claims . + Work closely with the Litigation Manager and/or Director and ... Litigation Adjuster will investigate, evaluate and handle to conclusion attorney represented injury claims , complex injury claims , and litigated claims . The… more
- AdventHealth (Maitland, FL)
- …Location** : Maitland, FL **The role you will contribute:** A Medical Economics Manager is responsible for overseeing the analysis and evaluation of financial and ... proposals, analyze fee schedules, and determine contract compliance. The Medical Economics Manager must have attention to detail and competencies in decision support… 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...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more
- GE Vernova (FL)
- **Job Description Summary** The Contract Manager will provide broad-based and thorough commercial contract management support to the Contract Management Regional ... with the overall project execution + Advise the Project Manager / Project Director of any improvements to the...the Contract for use as evidence in any later claims for extension of time; + Assist the Project… more
- Marriott (Lake Buena Vista, FL)
- …* Works with the unemployment services provider to respond to unemployment claims ; reviews provider reports for accuracy and corrects errors. * Prepares, audits ... * Ensures employee issues are referred to the Department Manager for resolution or escalated to the Director of...orientation, property meetings, bulletin boards, etc. * Conducts periodic claims reviews with Regional Claims office to… more
- Molina Healthcare (St. Petersburg, FL)
- …Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of ... healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more