- 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 ... full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000… more
- University of Miami (Miami, FL)
- …faculty. + Handles urgent patient escalations in collaboration with Practice Manager as necessary. + Credentialling and recredentialling of providers, maintaining ... list of licenses, DEAs, Medicaid /Medicare numbers. + Maintains files for Division of Rheumatology...+ Other duties as deemed necessary by Chief, Project Manager or Division Administrator. This list of duties and… more
- MyFlorida (Orlando, FL)
- …Community Based Organizations (CBO's). Incumbent reports to the Public Health Services Manager . Staff will establish and maintain a maximum caseload of 150 and ... refer clients with higher acuity to an Intensive Case Manager within the timeframes established by the service standards,...for other payor sources including, but not limited to, Medicaid , Medicare, or other available public or private programs.… more
- CHS (Clearwater, FL)
- …appropriate leadership, with accuracy, and work with the MPS Call Center Manager /Supervisor/Team Lead and analyze the data for training purposes. + Identifies ... variances related to claims and calls and provides feedback to their Manager . + Maintains up-to-date working knowledge on regulatory requirements associated with… more
- Molina Healthcare (St. Petersburg, FL)
- …National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), policies and procedures, quick reference guides (QRGs), audit ... skills. * Strong interpersonal skills. **PREFERRED QUALIFICATIONS:** * Certified Case Manager (CCM). To all current Molina employees: If you are interested… more
- Banner Health (FL)
- …with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General ... prior to referral to coding analyst, coding educator or coding manager /supervisor. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge and… more
- Elevance Health (Tampa, FL)
- …and Experience:** + Experience with large-scale healthcare or state Medicaid programs preferred. + Experience in management consulting, investment banking, ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Surgery Care Affiliates (Bonita Springs, FL)
- …class. + When the patient's insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers. ... the counter payments/deductibles/copay/co-insurance. Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines and workmen's… more
- Humana (Tallahassee, FL)
- …a critical moment of truth in the customer lifecycle. As Onboarding Program Manager , you will serve as the program lead for this enterprise-wide effort, reporting ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more