- Cognizant (Tallahassee, FL)
- …training regimen._ **Key Responsibilities-** + _Claims Processing:_ Review, validate, and process healthcare claims submitted by providers in accordance with US ... systems (Medicare, Medicaid, commercial payers). + 2-4 years of experience in US healthcare claims processing + Familiarity with claims management software… more
- Molina Healthcare (Jacksonville, FL)
- …but reside in Connecticut** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network ... utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more
- Molina Healthcare (Miami, FL)
- …DUTIES:** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, ... likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… more
- HCA Healthcare (Ocala, FL)
- …you to join Parallon which is part of the nation's leading provider of healthcare services, HCA Healthcare . **Benefits** Parallon offers a total rewards package ... on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny… more
- Molina Healthcare (Jacksonville, FL)
- …that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely ... Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education**… more
- Molina Healthcare (Jacksonville, FL)
- …of businesses. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and related financial data like risk score, revenue and cost. ... Medicaid, Marketplace and Medicare/MMP. + 5+ Years of experience in Prospective/Retrospective/ Audit targeting Analytics and Reporting. + 5+ Years of experience in… more
- Molina Healthcare (Miami, FL)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate… more
- Elevance Health (Tampa, FL)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... duties may include, but are not limited to:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in the… more
- Cardinal Health (Tallahassee, FL)
- …Expert-level knowledge of Medicare and Medicaid billing and documentation requirements; healthcare compliance audit methodology, principles and techniques; CMS ... the organization's reputation and support its mission to deliver trusted healthcare solutions. Job Summary Cardinal Health is seeking a driven, self-starter… more
- Elevance Health (Tampa, FL)
- …DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . Primary duties may include, but are not limited to: + Analyzes and ... audits claims by integrating medical chart coding principles, clinical guidelines,...clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise,… more