- Molina Healthcare (St. Petersburg, FL)
- **Job Description** **Job Summary** The Junior Analyst will play a supporting role on the RADV (Risk Adjustment Data Validation) team, assisting in the execution of ... collection. This is an ideal opportunity for an early-career analyst with a strong interest in healthcare data, regulatory...+ Basic familiarity with healthcare data types such as claims , encounters, or eligibility data + Comfortable working with… more
- Prime Therapeutics (Tallahassee, FL)
- …and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs,...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- CVS Health (Tallahassee, FL)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... + Pharmacy Investigative experience + Marketplace Broker Investigative experience + Medicaid and Medicare experience **Education** + Bachelor's degree in Criminal… more
- Molina Healthcare (Orlando, FL)
- …etc. **PREFERRED EXPERIENCE:** + SQL expertise + Excel expertise + Medicare, Medicaid , Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is ... generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.… more
- CVS Health (Tallahassee, FL)
- …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience. * Billing and Coding certifications… more
- Molina Healthcare (FL)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** +… more
- HCA Healthcare (Pensacola, FL)
- …to charitable organizations. Apply Today! **Job Summary and Qualifications** Processes claims electronically to insurance carriers. Mails claims to carriers ... to accounts. Communicates any charge related issues to Charge Master Manager/ Analyst . + Works all identified insurance requirement edits through the electronic… more
- Convey Health Solutions (Fort Lauderdale, FL)
- Job Description The Membership Accounting Analyst is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment, Billing and/or ... Reconciliation processes. The analyst will review documentation, work items in queues and...for correction and submission to Centers for Medicare & Medicaid Services (CMS) + Review and complete Late Enrollment… more
- Devereux Advanced Behavioral Health (Orlando, FL)
- …mission and culture? Then consider joining Devereux Florida as a Finance Analyst (Contracts / Managed Care)!_ Devereux provides mental and behavioral health services ... MMAs. + Coordinate with contract representatives and network providers to resolve claims issues. + Facilitate the credentialing process for new programs joining MMAs… more