- Humana (Tallahassee, FL)
- …in reporting tools such as SSRS or SSIS + Knowledge of Medicaid or Medicare services + Advanced data analytics skills and reporting experience to include working ... Science, Statistics, or related field + Experience working with Medicaid and Medicare data + Expertise in creating analytics solutions to drive decision making… more
- Humana (Tallahassee, FL)
- …best practices, and design clinical solutions for members who have Medicare and Medicaid. The Lead Product Manager partners across various multi-disciplinary ... our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager sits in...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Walmart (Orlando, FL)
- …on policy changes and new regulations; researching information to accurately process Medicare orders to ensure compliance ; and interpreting and documenting ... services to patients in accordance with local, state, and federal laws and corporate policies and procedures by assisting...a safe and clean work environment. + Complies with Medicare and Medicaid policies and procedures by implementing and… more
- CenterWell (Callahan, FL)
- …medicine, continuity of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the patient to specialists ... accordance with standards of care. . Follows level of medical care and quality for patients and monitors care..."on-call" program of Conviva as needed. . Assures personal compliance with licensing, certification, and accrediting bodies. . Spend… more
- AdventHealth (Altamonte Springs, FL)
- …patient notifications are provided and documented in a timely manner for compliance : Important Medicare Letters (IML), Medicare Outpatient Observation ... Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN Care Manager… more
- Banner Health (FL)
- …you. **Requirements:** + **5 years recent experience in acute-care Inpatient facility-based medical coding (clearly reflected in your attached resume);** + **DRG and ... knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment… more
- Humana (Tallahassee, FL)
- …have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key ... to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Evolent (Tallahassee, FL)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical… more
- University of Miami (Miami, FL)
- …necessary + Performs other duties as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population preferred ... evaluations. This role also works directly with staff, administration, medical directors, and other relevant stakeholders to assure appropriate...+ Completion of Medicare annual wellness exam documentation preferred + Knowledge of… more
- J&J Family of Companies (Jacksonville, FL)
- …support needs. + Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
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