- Molina Healthcare (St. Petersburg, FL)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (FL)
- …other Molina departments as needed + Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings ... education and work experience. + 3 years' experience in healthcare with a minimum of 2 years' experience in...of 2 years' experience in health plan member interventions, managed care, or equivalent experience. + Demonstrated solid business… more
- Molina Healthcare (Tampa, FL)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- Molina Healthcare (FL)
- …that support continuous quality improvement of the provider database, compliance with regulatory /accreditation requirements, and Network Management business ... equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider… more
- Molina Healthcare (Miami, FL)
- …opportunities for improvement of member outcomes + Oversees and ensures compliance with contractual, accreditation and regulatory requirements relative to ... **Job Description** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and… more
- Molina Healthcare (Miami, FL)
- …that would affect job performance. **Preferred Experience** + 5 years in the healthcare industry, managed care organization or equivalent experience. + Knowledge ... team, assisting the team in understanding pharmacy quality, cost effectiveness and compliance and working closely with the Pharmacy Director or AVP to ensure… more
- AdventHealth (Maitland, FL)
- …providers. Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms and provides appropriate ... guidance and direction to PFS, Central Denials, Patient Access and Managed Care staff regarding contract terms and policies including; governmental initiatives,… more
- Prime Therapeutics (Tallahassee, FL)
- …(corporate governance, dispute resolution, contract negotiation, employment law, audits/investigations, regulatory compliance ) + 3 years of experience advising ... visa or residency sponsorship **Additional Qualifications** + Advanced knowledge of PBM regulatory frameworks and healthcare law, with demonstrated ability to… more
- MyFlorida (Tallahassee, FL)
- …Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in ... candidate selected for this position is responsible for providing compliance oversight of the Managed Care Plans...*Two years of professional or nonprofessional experience in a regulatory or health service setting. *An associate's degree from… more
- Humana (Tallahassee, FL)
- …site of service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include ... medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements,… more
Recent Jobs
-
Director of Employee and Occupational Health
- HCA Healthcare (Richmond, VA)
-
Senior Investments Associate
- Quality Technology Services, LLC (Duluth, GA)
-
Womens Health Nurse-Practitioner (Open Rank) in the Non-Tenure Clinical Practice Track
- University of Colorado (Aurora, CO)
-
Facility Coding Inpatient DRG Quality
- Banner Health (OH)