- CenterWell (Wellington, FL)
- …treats center patients in accordance with standards of care. + Follows level of medical care and quality for patients and monitors care using available data and ... including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care. + Acts as an active participant and… more
- Humana (Miramar, FL)
- …Screen physician's orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request ... per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for… more
- MyFlorida (Tallahassee, FL)
- …and provider enrollment. The incumbent in this position shall remain informed about Medicare and other federal and state health care related programs, including ... to Medicaid providers. This position is responsible for supervising the Graduate Medical Education Unit (GMEU) and the Supplemental Payments Unit (SPU) housed within… more
- Elevance Health (Tampa, FL)
- …specific understanding in end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare / Medicaid regulatory policies regarding FFS and ... background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (ACA) rules. **Preferred… more
- Humana (Miramar, FL)
- …discrepancies between company records and those maintained by the Centers for Medicare and Medicaid Services. This role encompasses a range of moderately complex ... of 3 years' experience in the healthcare industry, with a strong understanding of medical terminology. + Proven background in medical billing, specifically as an… more
- AdventHealth (Altamonte Springs, FL)
- …national brand reputation. Responsible for executive oversight of state (AHCA) and federal (CMS) requirements for Institutes to ensure compliance across CFD. ... Collaborates with Regional CFD-S CEO and Chief Physician Executive for AH Medical Group to align specialty physician performance with health system strategic… more
- Humana (Tallahassee, FL)
- …submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the ... encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Select Medical (Ormond Beach, FL)
- …and maintain all corporate and clinical services required training and maintain compliance with state/local/ federal regulations + Evaluate, treat, direct, and ... team of clinicians treating primarily outpatient ortho with worker's compensation, medicare and vestibular rehab. Let's foster your growth! **Responsibilities** +… more
- Prime Therapeutics (Tallahassee, FL)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Humana (Tallahassee, FL)
- …analytics expertise, and a proven track record of leveraging data to meet compliance requirements and define and drive business value. The Senior Professional will ... analyze, synthesize, and present data related to benefit utilization, ensuring compliance with state reporting requirements and providing a comprehensive view of… more
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