- J&J Family of Companies (West Palm Beach, 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
- 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
- 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
- Humana (Tallahassee, FL)
- …time with demonstrated advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The nature of the work ... concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility… more
- Humana (Tallahassee, FL)
- …license in the state of residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability ... Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior… more
- HCA Healthcare (Orange Park, FL)
- …downgrade letters + Complex NCD/LCD guidelines, CMS/AHCA policies and regulations + Federal Register, Center for Medicare and Medicaid Services, American ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- Trinity Health (Fort Lauderdale, FL)
- …Pre-AR, AR, and Denial days.** **Maintains a working knowledge of applicable Federal , State, and local laws/regulations, the Trinity Health's Integrity and ... Compliance Program and Code of Conduct, as well as...level II coding guidelines, along with CCI edits and Medicare claims processing manual contents in a multi-facility, integrated… 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
- AdventHealth (Altamonte Springs, FL)
- …to provide feedback to CDI Market Leaders + Performs quality reviews of the medical record for compliance including completeness and accuracy for severity of ... allied health practitioners, nursing, and care management. This includes quarterly compliance updates from Medicare . + Effectively and appropriately communicates… more
- Highmark Health (Tallahassee, FL)
- …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts… more
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