- Evolent (Tallahassee, FL)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- Elevance Health (FL)
- …years at the executive level. + Proven track record of delivering large-scale healthcare technology solutions ( claims systems, care management platforms, or cost ... for building advanced analytics platforms, AI/ML-driven decision support tools, claims optimization systems, and clinical insights platforms that enable Elevance… more
- Evolent (Tallahassee, FL)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Molina Healthcare (FL)
- JOB DESCRIPTION **Job Summary** Provides support for provider claims adjudication activities including responding to providers to address claim issues, and ... researching, investigating and ensuring appropriate resolution of claims . **Essential Job Duties** * Provides support for resolution of provider claims issues,… more
- Molina Healthcare (FL)
- JOB DESCRIPTION **Job Summary** Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** * Serves as … more
- Molina Healthcare (St. Petersburg, FL)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Insight Global (Boca Raton, FL)
- …will have a solid foundation and proven track record in Commercial Healthcare Insurance including claims processing, products, and benefits management. The ... Skills and Requirements 5+ years of experience working within the Commercial Healthcare Insurance industry, including claims processing, products, and benefits… more
- Norstella (Tallahassee, FL)
- …(PharmD) or Medicine (MD/DO) degree. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory data, in an ... **The Role:** In this role, you will leverage your expertise in ** healthcare data analytics** to extract meaningful insights from **real-world data (RWD)** sources,… more
- Molina Healthcare (Jacksonville, FL)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise,… more
- Elevance Health (Tampa, FL)
- **Business Architect Sr. - Claims Systems** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... as required by law. The **Business Architect Sr. - Claims Systems** will be part of Elevance Health's National...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more