- Elevance Health (Tampa, FL)
- …Alternate locations may be considered. A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new ... the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How… more
- Prime Therapeutics (Tallahassee, FL)
- …combined pharmacy and PBM experience to include:##1 year of work experience in claims processing in an operations, audit or quality assurance environment##1 year ... for recoupment of audits and investigations performed by the Pharmacy Audit Operations and Special Investigations Unit (SIU) teams. **Responsibilities** + Perform… more
- Aston Carter (Miami, FL)
- …in systems and reporting, calculate and reconcile premiums, commissions, and claims , and perform basic accounting activities. Responsibilities + Analyze fronting ... to support strategic reinsurance placement. + Perform calculations for premium and claims allocation for quality control checks. + Validate the accuracy and… more
- Ascension Health (Jacksonville, FL)
- …and HCC knowledge Required** **Benefits** Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match ... the time of the offer._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting… more
- Sedgwick (Jacksonville, FL)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of all ... claims to ensure information substantiates disability. + Provides clear...status, progress and work status. + Achieves appropriate quality audit scores on a consistent basis. + Acts as… more
- Trinity Health (Fort Lauderdale, FL)
- …for the oversight and coordination of the day-to-day operations of the Regional Health Ministry's (RHM) Food & Nutrition Services (FANS) Department in a community ... effective cost reduction plans and implementation processes that support Trinity Health and RHM FANS goals, objectives, strategies, policies, and procedures. Ensures… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . Pharmacy Program Manager role includes: -Collaborate with an… more
- CVS Health (Tallahassee, FL)
- …or audit experience. **Preferred Qualifications** + Medicare experience + Claims experience + Experience in reading or researching benefit language in Summary ... At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming … more
- Intermountain Health (Tallahassee, FL)
- …of actual and budgeted contractual allowances and variances, monitoring of individual claims (logs), etc.). Interacts with HIM, PAS, and hospital finance staff as ... reimbursement methodologies. + Prepares or reviews cost reports and surveys, reviews audit adjustments and settlements, and files appeals and exception requests to… more
- Humana (Tallahassee, FL)
- …(Medical Coding or Healthcare (Medical Chart Review/Insurance Billing) or Internal/External Audit or Regulatory/Compliance OR Claims Investigations or Criminal ... **Become a part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations… more
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