- The Cigna Group (Sunrise, FL)
- …of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales ... + **Bachelor's degree strongly preferred in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in… more
- Datavant (Tallahassee, FL)
- …company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right ... team. Together, we're rising to the challenge of tackling some of healthcare 's most complex problems with technology-forward solutions. Datavanters bring a diversity… more
- CVS Health (Tallahassee, FL)
- …the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. ... services to team members. **Required Qualifications** * 2-4 years of experience healthcare field, medical/health setting, medical billing and coding * Experience in… more
- Humana (Tallahassee, FL)
- …Qualifications** + Bachelor's degree + Previous experience in prior authorization, claims , and/or utilization management in healthcare , health insurance, ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- MyFlorida (Orlando, FL)
- …requirements of s. 943.135. Preference will be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud Control Unit, or ... law enforcement experience, or five (5) years of work experience conducting healthcare fraud investigations. Note: All newly hired employees must obtain CJSTC Sworn… more
- University of Miami (Miami, FL)
- …leakage, and supporting system improvements that enhance revenue integrity across the healthcare enterprise. Working under the direction of the Director of Revenue ... a pivotal role in ensuring revenue integrity through: trend reporting and claims analysis, development of payor scorecards, Charge Description Master (CDM) reviews,… more
- Butterfly Effects (Deerfield Beach, FL)
- …you detail-oriented, compassionate, and ready to be part of a purpose-driven healthcare team? Butterfly Effects is looking for a Patient Medical Collection ... of contact for clients navigating benefits, payment responsibilities, and claims -providing the empathy, professionalism, and precision that our families deserve.… more
- CVS Health (Tallahassee, FL)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- Prime Therapeutics (Tallahassee, FL)
- …stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business partners ... duties as assigned **Education & Experience** + Bachelor's degree in business, healthcare , or related area of study, or equivalent combination of education and/or… more
- SIMEDHealth (Gainesville, FL)
- …to maximize collections and ensure compliance. + Oversee medical billing, claims submission, payment posting, and follow-up on outstanding accounts. + Collaborate ... accounts receivable experience is required (minimum 10 years in healthcare , including at least 5 years in healthcare... healthcare , including at least 5 years in healthcare finance leadership). + Proven supervisory and leadership experience… more