- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …in identifying and reporting variances in utilization of resources, avoidable days/ denials . Works in collaboration with Appeals Management/Medical Director in ... the appeals process. + Responsible for the appropriate use of software and applications and enters case management information accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to patient… more
- Ascension Health (Jacksonville, FL)
- …improvement, coding, quality and/or compliance processes. + Develop strategy and processes to reduce denials and audits. + Assist with appeals and length of stay ... market initiatives. + Utilize hospital data sources to identify & analyze patterns of over or under-utilization of services, quality metrics and collaborate with appropriate stakeholders to help achieve those goals. **About Ascension St. Vincent's Hospitals… more
- AdventHealth (Altamonte Springs, FL)
- …from Utilization Management staff involved in authorizations, concurrent review, and denials + Assists with interpretation of specific application of medical ... and making recommendations on appealed provider claims and makes determinations for appeals and grievances from patients; assists in drafting and submitting clinical… more
- AdventHealth (Tampa, FL)
- …claim denials to perform the appropriate resolution, rebilling, and/or appeals steps. Assists with developing and implementing strategies and procedures to ... reduce denials , maximize reimbursements, and promote faster payment. Resolves claim...to ensure successful claim submission. Monitor payer rejects and denials to determine systemic or data entry issues and… more
- Actalent (Miami, FL)
- …Skills + Certified Pharmacy Technician (CPhT). + Experience in pharmacy operations, appeals , managed care, claims processing, and handling denials . + Strong ... + Review submitted documentation and gather additional information to support the appeals process. + Forward completed cases to pharmacists for final determination.… more
- LogixHealth (Dania Beach, FL)
- …interpersonal communication, and experience in medical billing. Key Responsibilities: + Review denials on an explanation of benefits (EOB) statement + Review A/R ... reports to follow up on unpaid claims + Prepare and submit out appeals on claims that require additional review or reconsideration + Provide necessary documentation… more
- LogixHealth (Dania Beach, FL)
- …communication, and experience in third-party billing. Key Responsibilities: + Review/work denials on an explanation of benefits (EOB) statement + Analyze A/R ... to follow up on unpaid claims + Send out appeals on claims that require an appeal + Submit...professional healthcare billing + Familiarity with payer regulations, claims appeals processes, and denial reasons + Proficiency in EHR… more
- AdventHealth (Maitland, FL)
- …preventing achievement of such goal(s). Follows up on daily correspondence ( denials , underpayments) to appropriately work Patient accounts. + Assists Customer ... escalation to Supervisor/Manager if necessary. + Processes administrative and Medical appeals , refunds, reinstatements and rejections of insurance claims with the… more
- Option Care Health (Tallahassee, FL)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... time frame. Generates and mails statements and collections letters. Follows-up on all denials within 48 hours of receipt. + Ensures compliance with policies and… more
- Monte Nido (Miami, FL)
- …level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals . + Engage in clinical rounds as an active treatment team member ... leadership, clinicians, and admissions regarding status of client authorization, potential denials , and potential for private payment. + Follow workflow and medical… more