- Molina Healthcare (Jacksonville, FL)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Kyndryl (Tallahassee, FL)
- …Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the US is ... $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be… more
- AdventHealth (Ormond Beach, FL)
- …safety, and learning systems. + Identifies and reports occurrences with potential claims to the Director of Risk Management per established protocol. ... contribute:** The Patient Safety Coordinator (PSC) under the direction of the Director of Risk Management is responsible for implementation and coordination of… more
- City of Lakeland (Lakeland, FL)
- …the following areas: risk determination and evaluation, oversight of claims administration, city-wide contract administration regarding insurance requirements and ... initiatives/clinic. Responsibilities include directly supervising Safety, Health Benefits, and Claims Team Leaders; Risk Management support staff and Wellness… more
- AdventHealth (Maitland, FL)
- …methodology, data tools, modeling, managing revenue, and managing and mentoring of director reports. Must be able to complete extensive and complex financial, ... sources using knowledge of healthcare managed care contracts and healthcare administrative claims data Reviews existing complex models and implements them on new… more
- Carnival Cruise Line (Miami, FL)
- …reviewing care plans, coordinating with internal stakeholders, supporting disability claims , and facilitating return-to-work planning. The Manager also escalates ... compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return...bonus program, while sales roles have an incentive plan. Director and above roles may also be eligible to… more
- Sunrise Senior Living (Boca Raton, FL)
- …programs support to the community team members, department coordinators and Executive Director which meet and or exceed Sunrise quality service standards. Key areas ... with department coordinators for approved corrections. + Notify Executive Director of excessive payroll variances. + Process approved labor/labour adjustments… more
- MyFlorida (Bay Pines, FL)
- …Responds to scheduling inquiries from County Veteran Service Officers, and refers all claims and hospital inquiries to the Veterans' Claims Examiner Supervisors ... to take in contacting state and county assistance. Conserves Director 's time by reading, researching, and routing correspondence; drafting...in the Bureau of Field Services and Bureau of Claims Services receive training on new VA policies, Federal… more
- Carnival Cruise Line (Miami, FL)
- …planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. + ... duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk...bonus program, while sales roles have an incentive plan. Director and above roles may also be eligible to… more
- Guidehouse (Tampa, FL)
- …remote **What You Will Do** **:** + Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialistprovides revenue cycle ... plan when needed + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold… more