- Molina Healthcare (FL)
- …or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working ... to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of...within the core processing system (QNXT). * Conducts focal healthcare Medical claim audits on samples of… more
- Molina Healthcare (Tampa, FL)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge ... refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. **JOB QUALIFICATIONS** Graduate from an...two years of experience in Claims Auditing, Medical Necessity Review and Coding experience +… more
- Molina Healthcare (FL)
- …different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form) + Demonstrated understanding of key managed ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- Molina Healthcare (Orlando, FL)
- …different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form) + Demonstrated understanding of key managed ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- Molina Healthcare (FL)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... with various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation… more
- CVS Health (FL)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... and is ideal for a data professional with strong coding skills in SQL and Python who can transform...skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,… more
- AdventHealth (Maitland, FL)
- …it relates to reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 ... relates to reimbursement methodologies + Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10… more
- HCA Healthcare (Sarasota, FL)
- …remote position Introduction Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with purpose and integrity. ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...+ Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family… more
- LogixHealth (Dania Beach, FL)
- …Required: + Minimum 2-3 years of A/R follow-up experience in professional healthcare billing + Familiarity with payer regulations, claims appeals processes, ... LogixHealth, you will work with a team of fellow medical billers, administrators, and coders to provide cutting edge...management services, offering a complete range of solutions, including coding and claims management and the latest… more
- Zelis (FL)
- …policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and ... working knowledge of Health Insurance, Medicare guidelines and various healthcare programs + Understanding of hospital coding ...and billing rules + Clinical skills to evaluate appropriate Medical Record Coding + Experience conducting root… more
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