- CVS Health (Tallahassee, FL)
- …issues. + Manages operational aspects of the team (eg, budget, performance, and compliance ), and implements workforce and succession plans to meet business needs. + ... of 3 years managing/leading a team. + Experience working in Medicare, Medicaid , or Commercial Health Insurance. **Preferred Qualifications** + Experience working in… more
- Healthfirst (FL)
- …implementing statistics and process control tools; and maintaining effective compliance and corrective action procedures. + Demonstrated knowledge in creating ... of at least two or more lines of business such as Medicare NY/NJ, Medicaid , Family Health Plus, Child Health Plus, NH Family + Experience managing a Quality… more
- Molina Healthcare (Miami, FL)
- …and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees budget responsibilities ... type management responsibility. 5 years progressive experience supporting a Medicaid ,.Medicare and Marketplace or large claims processing environment with… more
- Molina Healthcare (St. Petersburg, FL)
- …our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role ... will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and regulatory guidance. The… more
- Molina Healthcare (Tampa, FL)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...that drive measurable improvement. + Partners with finance and compliance to develop business cases and support reporting that… more
- Humana (Miramar, FL)
- …of applicable CPT, HCPC, ICD-10 codes, and all insurance contracts. Understand Medicare/ Medicaid criteria and Health Plan policies to ensure the referral meets all ... issues with referring entities or providers that delay service delivery to manager . Provides excellent internal and external customer service by ensuring work meets… more
- HCA Healthcare (Orange Park, FL)
- …guidelines in all interactions with the patient + In conjunction with the Medicaid Eligibility Staff visit all uninsured patients in-house + Provide estimates to ... + Assist patients with payment arrangements and in co-ordination with the Medicaid Eligibility Staff assists patient with financial applications + Contact patient… more
- Humana (Tallahassee, FL)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required...to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through… more
- Elevance Health (Tampa, FL)
- …specific understanding in end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare/ Medicaid regulatory policies regarding FFS and ... using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (ACA) rules....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CenterWell (Tallahassee, FL)
- …experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + ... degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more