- CVS Health (Tallahassee, FL)
- …**Position Summary** As a Rep II, Operations, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. ... company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while… more
- BayCare Health System (Clearwater, FL)
- …developing leadership skills and may interact periodically with all levels of management . + This position is responsible for government payer reimbursement related ... to Medicare , Medicaid...and staying current on all government regulatory changes and CMS /Federal and State proposals to change reimbursement methodologies and… more
- Humana (Tallahassee, FL)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Elevance Health (Tampa, FL)
- …Senior** is responsible for analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ... data quality management processes and procedures. + Provide support for CMS audits and other regulatory reporting requirements. + Develop and analyze business… more
- Humana (Tampa, FL)
- …Bachelor's degree + 10 plus years' experience in health insurance operations, complaint management , and CMS STARs programs (experience in large national insurers ... serve as a strategic leader overseeing initiatives to improve CMS STAR ratings and manage Complaint Tracking Metrics (CTMs)...annual revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices… more
- Humana (Miramar, FL)
- …supervision, while effectively managing multiple priorities. + Familiarity with Centers for Medicare and Medicaid Services ( CMS ) regulations is preferred. + Must ... discrepancies between company records and those maintained by the Centers for Medicare and Medicaid Services. This role encompasses a range of moderately complex… more
- Molina Healthcare (Tampa, FL)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- Elevance Health (Tampa, FL)
- …equivalent background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services ( CMS ) and Affordable Care Act (ACA) ... has experience working in leading healthcare payer claims/ revenue cycle management (RCM) organizations, with specific understanding in end-to-end claims/ encounter… more
- Intermountain Health (Tallahassee, FL)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more
- Molina Healthcare (St. Petersburg, FL)
- …for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare , and Marketplace lines of business. This includes direct management ... to support efficient and compliant subrogation operations across Medicaid, Medicare , and Marketplace populations. + Collaborate with legal, claims, provider… more