- Prime Therapeutics (Tallahassee, FL)
- …analysis to include 5 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field** **3 years of experience ... using Tableau, SQL, SAS, Alteryx, Teradata, R, or Python technologies** **Must be eligible to work in the United States without the need for work visa or residency sponsorship** **Additional Qualifications** **Extensive PBM industry knowledge and deep… more
- Molina Healthcare (FL)
- JOB DESCRIPTION **Job Summary** Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Oracle (Tallahassee, FL)
- …and predictive analytics. * Apply generative AI to synthesize insights from multi-modal healthcare data (eg, EHRs, imaging, claims , and demographics) to enhance ... Oracle Health Data Intelligence (HDI) is leading the charge in transforming healthcare with innovative data and AI solutions. We're seeking a highly skilled… more
- Molina Healthcare (Tampa, 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
- Molina Healthcare (Orlando, FL)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the… more
- Molina Healthcare (Tampa, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- Molina Healthcare (Tampa, FL)
- … healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms ... related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more
- Humana (Tallahassee, FL)
- …+ 2 or more years of project leadership experience + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS measurement** ... bridges product ownership, data and software engineering, and regulatory healthcare data requirements, ensuring that data ingestion, transformation, and delivery… more
- HCA Healthcare (Sarasota, FL)
- …CBO office** **Introduction** Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with purpose and integrity. ... + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family...will be responsible for daily charges, preparing and submitting claims to third party payers, applying contractual adjustments, credit… more
- HCA Healthcare (Kissimmee, FL)
- **Description** **Introduction** Last year alone, HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a(an) Manager Patient Safety ... 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