- 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 (Tampa, FL)
- **Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law._ The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Akumin (Kissimmee, FL)
- …imaging procedures from insurance companies. Provides supporting documentation for all insurance appeals and denials. + Other duties as assigned. **Position ... Requirements:** + High School Diploma or equivalent experience. + CPR Certification. + 1 year in medical/hospital setting + **Interpersonal Skills:** Relationship building skills to work with all functional units of the organization effectively. Experience in… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and ... documentation to determine if an appeal or further request is warranted. The Appeals Representative 4 IRT (Internal Review Team) + Review documents + Building cases… more
- Cognizant (Tallahassee, FL)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Medicare, Medicaid, and third-party guidelines. . Effectively document and log claims/ appeals information on relevant tracking systems . Utilize critical thinking… more
- CenterWell (Tallahassee, FL)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- Elevance Health (Miami, FL)
- **Medical Director-Dermatology Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law. The **Medical Director-Dermatology Appeals ** is responsible for the review of appeals for physical health… more
- Lincoln Financial (Tallahassee, FL)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter expert to ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Appeals and Grievances** at Evolent is responsible for reviewing and processing case ... rather than phone and fax activities. **Collaboration Opportunities** : The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as… more
- Humana (Tallahassee, FL)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... + Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more