- Molina Healthcare (St. Petersburg, FL)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- CVS Health (Tallahassee, FL)
- …risks and issues is essential. Additional responsibilities include: - Supporting the annual CMS bid filing for the Group Medicare business. - Reviewing annual ... BID cycle and the review of the yearly CMS required member materials. This role will interact daily...SME. **Required Qualifications** 2+ Years working in the MPDT system 4+ Years Employer Group Medicare industry… more
- CVS Health (Tallahassee, FL)
- …+ Ensuring that the relevant information is captured in Customer Relationship Management system (CRM) + Other duties as assigned. **Accountabilities** : ... an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part...and standards with a robust knowledge with respect to CMS and states regulations. + Ability to multitask, and… more
- Humana (Tallahassee, FL)
- …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- Molina Healthcare (Jacksonville, FL)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- Humana (Tallahassee, FL)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- Actalent (Orlando, FL)
- Job Title: Medicare Coverage Analyst - QC Job Description The Medicare Coverage Analyst (MCA) is responsible for conducting detailed reviews of clinical trial ... to determine the appropriate billing of services in compliance with Medicare regulations and institutional policies. This role ensures that billing practices… more
- BayCare Health System (Clearwater, FL)
- …area:** + BayCarePlus Medicare Advantage Plans (https://baycare.org/ medicare -advantage-plans) **Facility:** BayCare Health System , Sales-BHS **Location:** ... Plans and be responsible for prospecting and selling BayCarePlus Medicare Advantage plans to our Medicare community....+ Must adhere to all regulations set forth by CMS and maintain BayCare's values and ethical standards. **Minimum… more
- Molina Healthcare (St. Petersburg, FL)
- …average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services ( CMS ) regulations. + Ensures that adequate staffing ... for review. + Assures that activities and processes are compliant with CMS and National Committee of Quality Assurance (NCQA) guidelines and Molina policies… more
- Molina Healthcare (St. Petersburg, FL)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more