- Elevance Health (Tampa, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Elevance Health (Miami, FL)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… 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 ... Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Humana (Tallahassee, FL)
- …**Required Qualifications** + Bachelors Degree + Minimum of 3 years of medical claims auditing experience (interpreting if claims initially paid correctly in the ... Payment Integrity (formally known as Financial Recovery) experience + CAS claims knowledge + Prior vendor relationship experience/knowledge + Intermediate knowledge… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …enhance communication strategies, ensuring seamless and personalized interactions with healthcare professionals (HCPs) and key opinion leaders (KOLs). **Job ... Management** + Explore and analyze common pharmaceuticals data (eg, claims ) as well as novel data sets based on...performance. + Agile skills and experience + Experience in Healthcare (esp. US) industry is a plus. **Competencies** **Accountability… more
- Carnival Cruise Line (Miami, FL)
- …reviewing care plans, coordinating with internal stakeholders, supporting disability claims , and facilitating return-to-work planning. The Manager also escalates ... planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. +… more
- Otsuka America Pharmaceutical Inc. (Gainesville, FL)
- Otsuka America Pharmaceutical Inc. is a global healthcare company with the corporate philosophy: "Otsuka-people creating new products for better health worldwide." ... its evolved customer engagement model, a Hospital Specialist engages healthcare providers (HCPs) using in-person, virtual, and digital tools,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …factors influencing US market access, including reimbursement trends, payer concerns and healthcare policy + Strong understanding of the US payer environment, payer ... market dynamics, payer marketing principles and how healthcare players make decisions across private & public channels...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Highmark Health (Tallahassee, FL)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... understanding of healthcare terminology, techniques,...including, but not limited to: medical/surgical physician and institutional claims and encounters, clinical data, prescription drug data, membership… more
- Owens & Minor (Tallahassee, FL)
- At Owens & Minor, we are a critical part of the healthcare process. As a Fortune 500 company with 350+ facilities across the US and 22,000 teammates in over 90 ... of what we do. Our mission is to empower our customers to advance healthcare , and our success starts with our teammates. Owens & Minor teammate benefits include:… more