- Humana (Tallahassee, FL)
- …an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, and outpatient services and equipment, within their scope. The ... other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. +… more
- Humana (Tallahassee, FL)
- …an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. ... other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. +… more
- HCA Healthcare (Tallahassee, FL)
- …plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving ... assistance, pet insurance and more. + Free counseling services and resources...make notes regarding payment.** 1. **Reviews daily preservice log, appeals inventory, and write-offs on a daily basis, reports… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case management and member ... in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible… more
- HCA Healthcare (Bradenton, FL)
- …plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving ... assistance, pet insurance and more. + Free counseling services and resources...analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case management, and… more
- Elevance Health (Tampa, FL)
- …report reopenings. + Under guided supervision, participate in completing more complex appeals related work: + Position papers + Jurisdictional Reviews + Maintaining ... review of cost report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB Hearings + Administrative… more
- Centene Corporation (Tallahassee, FL)
- …including Formulary Services, Pharmacy Operations, Medication Therapy Management (MTM), Appeals , Specialty Pharmacy, and Quality. Will be assigned specific ... and education. + Participates in the prior authorization review and appeals processes. + Participates in the organization's quality management and improvement… more
- TEKsystems (Tampa, FL)
- …will be on the bill review team specifically working in the backlog of appeals . The Bill Review Analyst position holds accountability for accurate and timely review, ... of bills to include pre-coding accuracy and adjudication of appeals /provider reconsideration requests. Job Type & Location This is...- Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and… more
- Highmark Health (Tallahassee, FL)
- …requests for medication coverage determination for prior authorization review and appeals . Through the Utilization Review system, the incumbent evaluates clinical ... coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the… more
- Elevance Health (Miami, FL)
- …and/or serve as a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations. + Obtain additional state ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of company… more