- Molina Healthcare (Orlando, FL)
- …or equivalent combination of education and experience **Required Experience** + Min. 3 years managed care experience + Experience in one or more of the ... following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar. + Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria. **Preferred Education** Bachelor's Degree… more
- Molina Healthcare (Orlando, FL)
- …**N** **C** **E:** + 3+ years of medical record abstraction experience + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA. **PR** **E** ... **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I**… more
- Grifols Shared Services North America, Inc (Sarasota, FL)
- …presentations to appropriate groups such as the following: key accounts, managed care organizations, integrated systems, national medical associations, and ... medical schools. Acts as an "ambassador" representing Grifols' position and interests. + Participates and contributes in cross-functional teams (eg, sales, marketing, global medical affairs) regarding field-based activities, medical insights, competitor… more
- Molina Healthcare (St. Petersburg, FL)
- …adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either ... at a health plan or vendor-is strongly preferred. **Knowledge/Skills/Abilities** + Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes and identify trends or… more
- Molina Healthcare (St. Petersburg, FL)
- …for both internal staff and vendor oversight. + Experience working within a Managed Care Organization (MCO) or health plan environment. + Proven ability ... to manage complex vendor relationships and recovery strategies (eg, first-pass and second-pass vendor models). + Strong understanding of federal and state regulations related to subrogation, including HIPAA, Medicaid TPL requirements, and CMS guidelines. +… more
- Pearle Vision (Orange Park, FL)
- …Company average * Calls to customers to follow-up on purchases * Maximize Managed Vision Care relationships and sales opportunities. * Timely implementation of ... team in a positive and productive environment, modeling exemplary patient care . Develop and maintain outstanding associate and doctor satisfaction and retention.… more
- Pearle Vision (Gainesville, FL)
- …Company average * Calls to customers to follow-up on purchases * Maximize Managed Vision Care relationships and sales opportunities. * Timely implementation of ... processes in a positive and multi-tasking environment. Modeling exemplary patient care . Develop and maintain outstanding patient, associate and doctor satisfaction… more
- Pearle Vision (Brandon, FL)
- …Company average * Calls to customers to follow-up on purchases * Maximize Managed Vision Care relationships and sales opportunities. * Execution of operational ... the team in a positive and productive environment, modeling exemplary patient care . Develop and maintain outstanding associate and doctor satisfaction and retention.… more
- Prime Therapeutics (Tallahassee, FL)
- …Examiner credential preferred. + Bachelor's degree preferred. + Prefer knowledge of managed health care business model and processes, preferably in behavioral ... for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded...and work collaboratively to provide the highest quality of care and service to our members. If you are… more
- Pearle Vision (Lakeland, FL)
- …and realistic delivery time quotes. * Provide appropriate guidance to patients regarding Managed Vision Care . * Assist the store with being effectively ... providing exceptional customer service and quality products to ensure the best possible vision care for our clients. As one of the top performing locations in the… more