- 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...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… 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 ... is granted as required by law. The **Medical Director-Dermatology Appeals ** is responsible for the review of appeals...of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for… more
- Elevance Health (Miami, FL)
- …for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to identify ... to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when… more
- MyFlorida (Gulf Breeze, FL)
- …coming from the benefits that the State offers. As a full-time employee, your insurance rate will be significantly low due to the contribution of the State of ... While the rates are higher for halftime employees, health insurance options are still available if you are in...as directed by the Director of Pro Bono and Appeals or the Circuit Director. + Responsible for developing… more
- HCA Healthcare (Loxahatchee, 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...to the infection control, risk management, safety, and medical staff credentialing functions, ensuring the collaboration and coordination of… more
- Amgen (Orlando, FL)
- …the entire reimbursement journey through payer prior authorization to appeals /denials requirements and forms + Review patient-specific information in cases ... during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal,… more
- Elevance Health (FL)
- …Operations Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. ... treatment regimens. + As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered… more
- HCA Healthcare (Miramar, FL)
- …timely manner with CBO Director/Assistant Director. + Reviews filing and follow-up on insurance denials for all collectors to assure appeals are completed within ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving… more
- Sarasota County Government (Sarasota, FL)
- …provide informed recommendations. + Draft Zoning Letters of Determination and support appeals , development reviews, and Board of Zoning Appeals activities under ... + Enjoy great benefits including Health, Dental, Vision, and Life Insurance , Short-Term and Long-Term Disability, Flexible Spending Accounts, Employee Assistance… more
- AdventHealth (Orlando, FL)
- …Wellbeing Resources + Mental Health Resources and Support + Pet Insurance * + Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense) ... teams. Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures,… more