- Elevance Health (Miami, FL)
- …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
- Elevance Health (FL)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of… more
- Highmark Health (Tallahassee, FL)
- …This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Highmark Health (Tallahassee, FL)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Highmark Health (Tallahassee, FL)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... audit activities. Reviews medical records to determine data quality...of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines.… more
- Highmark Health (Tallahassee, FL)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Sedgwick (Tallahassee, FL)
- …United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, ... FUNCTIONS and RESPONSIBILITIES** + Consults on and evaluates complex claims to determine objective, quantifiable, medically supported work restrictions/accommodations.… more
- Sedgwick (Tallahassee, FL)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- Walmart (Orlando, FL)
- …rotating merchandise and supplies from distribution centers and suppliers; handling claims and returns; completing, maintaining, and securing paperwork, forms, and ... process Medicare orders to ensure compliance; and interpreting and documenting Medicare audit documents. + Ensures fulfillment of pharmacy prescriptions in a Home… more
- MyFlorida (Spring Hill, FL)
- …correctness and completeness of payments. Payments are posted to receivable accounts in the Health Management System. Any claims not paid in full are noted and ... Website (http://www.dms.myflorida.com/workforce\_operations/human\_resource\_management/for\_job\_applicants/e\_verify) . Requisition No: 853691 Agency: Department of Health Working Title: ACCOUNTANT SUPERVISOR II - SES -… more