- Humana (Tallahassee, FL)
- …have met all company training requirements for company, quality, and regulatory compliance . + Analyzes course evaluations to judge the effectiveness of training ... successfully working as a Care Manager/Care Coach/Care Coordinator/Service Coordinator in a Medicare or Medicaid market **OR** two (2) or more years of professional… more
- Molina Healthcare (Tampa, FL)
- …and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary ... therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics… more
- Evolent (Tallahassee, FL)
- …Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... make denial determinations as a specific case warrants. + Converses with medical office staff in order to obtain additional pertinent clinical history/information;… more
- Humana (Tallahassee, FL)
- …Coding Educator is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with providers to enhance ... guidelines + Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes… more
- Zelis (St. Petersburg, FL)
- …standard inpatient coding guidelines, and supporting the Office of the Chief Medical Officer in managing disputes related to clinical claim reviews. This position ... + Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional bill review opportunities. + Support for client facing… more
- CenterWell (Tallahassee, FL)
- …collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- University of Miami (Miami, FL)
- …facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents that must be presented and thoroughly explained to the ... HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer… more
- Aveanna Healthcare (Fort Myers, FL)
- …quality of care and performs home visits as needed. + Ensures client compliance with federal /state regulations through policy and procedure administration to ... to provide supervision of all clinical staff working with high medical acuity clients and/or clients receiving extended non‐licensed support services. This… more
- WelbeHealth (Tallahassee, FL)
- …ASC 606, revenue operations, control environment, and all required state and federal reporting requirements. Fulfillment of the role will also include driving ... efficiency in compliance reporting/revenue rate filings and leveraging insights to improve...improve financial performance and internal communication of state and federal plan adjustments. Additionally, this role is expected to… more
- Highmark Health (Tallahassee, FL)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, member facing outreach initiatives + Develop… more