- Humana (Tallahassee, FL)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS + ... and with a team **Preferred Qualifications** + BS in healthcare or business-related field + Knowledge of internal Medical...field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing… 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
- Cleveland Clinic (Weston, FL)
- …Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare . Cleveland Clinic is recognized as one of the top hospitals in ... a rewarding career with one of the most respected healthcare organizations in the world. As a Senior International...terms, legal issues and contract analysis + Experience with claims payment methodologies and operations + Working knowledge of… more
- Carnival Cruise Line (Miami, FL)
- …planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. + ... to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk and escalate to the… more
- Humana (Tallahassee, FL)
- …2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives, ... 2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives,… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …Competencies** **K** **nowledge** - Experience working in the pharmaceutical and/or healthcare industry. - Knowledge and experience with preparation of global ... clinical development, project management, quality assurance, etc.) in pharmaceutical or healthcare related industry. Experience with FDA or other health authority… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …Access, or payer experience + Thorough understanding and knowledge of US healthcare economics and the drivers of pharmaceutical demand, including pricing and ... chain and its business processes + Extensive experience in healthcare contracting and in-depth understanding of GPO/PBM/National and Regional...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Tampa, FL)
- …**Financial Operations Recovery Specialist** is responsible for setting up and adjusting claims overpayments that have been previously identified. May do all or some ... will make an impact:** + Reviews and validates paid claims for overpayments using various techniques including system-based queries,...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Humana (Tallahassee, FL)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... operational knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). + Collaborate with each Insurance Operations… more