- Humana (Tallahassee, FL)
- …with our Security Automation Product Owner, Product Security Product Manager , Product Security Governance, DevOps, Enterprise Information Protection and Enterprise ... Information Systems Security Professional * (CISSP), Certified Information Security Manager (CISM), Certified Information Systems Auditor (CISA) or other similar… more
- Molina Healthcare (St. Petersburg, FL)
- …answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is present ... leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. + Responsible for key… more
- HCA Healthcare (Miami, FL)
- …Reasons + Communicate coding revisions to the applicable party (eg, CIS, lead, manager , international log) + Periodically works with manager to review individual ... registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance , credentialing, health information management, customer service, payroll and… more
- Humana (Belle Glade, FL)
- …on patient plan of care. Report's problems/potential problems to RN/Case Manager .forward and of moderate complexity. The Licensed Practical Nurse participates in ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …billing * Conduct census balancing and payor verification * Verify insurance and Medicaid coverage * Handle Dual Coverage, Medicare Part D, and Commercial Plans ... summaries * Assist residents with account balances * Ensure compliance with HIPAA and other regulations * Adhere to...* Perform additional duties as assigned by the Billing Manager Qualifications QUALIFICATIONS * High school diploma or equivalent… more
- HCA Healthcare (Ocala, FL)
- …Calc Engine + Performance of ad hoc analyses as assigned by departmental Director, Manager and Team Leads + Performs Peer to Peer (Independent Review) for model ... registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance , credentialing, health information management, customer service, payroll and… more
- CenterWell (Tallahassee, FL)
- …experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care **Additional ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Tallahassee, FL)
- …largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical, ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Tampa, FL)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid , Medicare, CHIP and Marketplace, applicable State regulatory requirements,… more
- CenterWell (Miami, FL)
- …+ Assist patients with applying for services available through DCF such has Medicaid , and Food stamps. + Provide any extra assistance available through government ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more