- CVS Health (Tallahassee, FL)
- …Revenue Integrity initiatives. + Responsible for leading the reconciliation of data ( coding review results and medical record images) from different sources, ... support of auditing activities related to vendor reconciliation of coding results and medical record images as well as...to meeting business needs. + Tightly managing vendor data quality and timeliness; ensure data is ingested into CREW… more
- Molina Healthcare (Orlando, FL)
- …Utilization Management and Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases in conjunction with ... specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
- Prime Therapeutics (Tallahassee, FL)
- …in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse ... data to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerability. + Contact… more
- Cardinal Health (Tallahassee, FL)
- …patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to ... interaction using the appropriate database for the inquiry + Self- audit intake activities to ensure accuracy and efficiency for...1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience + 1-2 years experience with Prior… more
- TECO Energy (Tampa, FL)
- …performing similar functions outside of IT) in efficient SQL and NoSQL coding techniques for optimum database and application performance. + Create, conceptualize, ... design and maintain data processes, data reliability, data efficiency, data quality , data storage, data models, data performance, data ingestion, all in support of… more