- Elevance Health (Tampa, FL)
- ** Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... quality of life through home-care and community based services. The ** Clinical Document Improvement Director** is responsible for leading encounter processing,… more
- Molina Healthcare (Jacksonville, FL)
- …Claim Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from… more
- Molina Healthcare (Miami, FL)
- …proactively identifying, validating, and tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Prime Therapeutics (Tallahassee, FL)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** ... + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and programs… more
- Elevance Health (Tampa, FL)
- … documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Tampa, FL)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... ** Clinical Fraud Investigator II - Registered Nurse and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Walgreens (Orange Park, FL)
- …of medications and drug interaction awareness. Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient outcome ... (eg patient consultation, medication management, drug therapy reviews, and perform clinical , or wellness services such as immunizations, diagnostic testing, and… more
- Walgreens (Miami, FL)
- …and federal laws/regulations allow, accountable for performing day-to-day non- clinical pharmacy operations, administrative activities; Ensures efficient pharmacy ... to customers' requests in a timely manner and answers non- clinical questions to ensure a positive customer experience. Models...efficient workflow. + At the direction of the Pharmacy Manager or pharmacist, prepares, and files reports and records… more
- CVS Health (Largo, FL)
- …and inform members about available benefits and services. + **Reporting & Analytics:** Review and interpret data related to claims , utilization, and service ... + **Issue Escalation & Follow-up:** Collaborate cross-functionally with internal teams (Eligibility, Claims , Clinical ) to track and resolve complex or repeated… more