- Point32Health (FL)
- …as a customer service or member services representative in health care or insurance + Preferred: 2 years' Appeals and Grievance experience **Skill Requirements** ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and...NCQA (National Committee for Quality Assurance), DOI (Dept of Insurance ), CMS, DOL and any state or federal specific… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Elevance Health (FL)
- **Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, with ... will be necessary and is dependent on court hearing schedules. The **Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing and… more
- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. * Represents Molina… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews for physical health… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- Cardinal Health (Tallahassee, FL)
- …maintain optimal account receivables performance and client satisfaction. + Resolves complex insurance claims, including appeals and denials, to ensure timely ... as a subject matter expert in claims processing. + Processes claims: investigates insurance claims; properly resolves by follow-up & disposition. + Lead and manage… more
- Cardinal Health (Doral, FL)
- …queue as assigned in the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate ... right things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work within the scope of… more
- HCA Healthcare (Ocala, FL)
- …Minimum two years related experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving… more
- University of Miami (Doral, FL)
- …criteria. + Assists physicians and clinic staff with filing charges, billing, and insurance authorizations and appeals as needed. + Adheres to University and ... unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education:… more