- AdventHealth (Orlando, FL)
- …other regulatory requirements. Operationalizes and assures compliance with Centers for Medicare and Medicaid ( CMS ), Occupational Safety and Health Administration ... (OSHA), Center for Disease and Prevention (CDC) and Patient Safety regulations at the campus level. Adheres to applicable practice standards that relate to their area of specialty. . Operating & Capital Budget/Financial Responsibility: * Analyzes financial… more
- AdventHealth (Maitland, FL)
- …to grow value-based products in the Central Florida Division, including Medicare Advantage, commercial payers, direct to employer agreements, managed Medicaid and ... various CMS programs and bundled payments. . Fosters effective collaboration...implement tactically. . Approaches his/her work as an interconnected system . Ability to understand major objectives and break them… more
- AdventHealth (Tampa, FL)
- … department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Discharge Planning, ... a well-balanced work life balance **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall… more
- AdventHealth (Orlando, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... inpatients and 125,000 outpatients each year **The role you'll contribute:** **The Care Management Manager is under the general leadership of the Care Management … more
- Molina Healthcare (FL)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Humana (Tallahassee, FL)
- …inventory monitoring and assignment of escalated inventory + Research on guidelines - CMS , AMA, etc. + Training new coders/auditors + Responsible for updating and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Cognizant (Tallahassee, FL)
- …+ Experience making payments with UB/institutional ( CMS -1450) and/or professional ( CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage ... and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper...and external SLAs. + Other duties as assigned by management . **Qualifications:** + A minimum of 2 years' claims… more
- HCA Healthcare (Fort Myers, FL)
- …are met. 2. Creates and maintains a positive relationship with the hospital Case Management team. 3. After a referral from the hospital CM, meets with patients to ... acceptance including support of electronic platform referrals. Ensures the patient meets CMS criteria for home health services. 5. Ensures required documentation is… more
- Banner Health (FL)
- …and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services ( CMS ), Office of the Inspector General (OIG) and the ... (RHIT), in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Certification… more
- Healthfirst (FL)
- …with internal teams (eg, sales, customer service, compliance) to ensure seamless management of members. + Monitor ,report, and deliver updates on memberships, data ... Billing activities are managed in compliance with State and CMS guidelines and to ensure member satisfaction + Lead...Working knowledge of how data processes through systems and system integrations work to understand and plan for addressing… more