- Healthfirst (FL)
- …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 ... Assurance or Operations Audit team. + Experience working with AI or other machine learning tools to assist with streamlining QA processes. + Experience working with delegates/vendors in a healthcare insurance setting. + Demonstrated experience or deep… more
- Philips (Miami, FL)
- …and obtaining medical record documentation. + Be an expert on Medicare, Medicaid and private insurance coverage-criteria for InCourage vest therapy. Be able to ... effectively educate healthcare teams in identifying patients who meet coverage criteria. + Ability to analyze data to effectively target priority healthcare teams and create sales call routing. Capable to be flexible and adjust routing to fit pipeline… more
- Healthfirst (FL)
- …like Tableau and Knowledge of NY lines of business such as Medicare NY, Medicaid , Child Health Plus, QHP, EP, HARP + Bachelor's degree in Accounting, Finance, or ... Business Administration from an accredited institution preferred. + Certification in claims processing or related area (eg, CPC, AIC) WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard… more
- US Tech Solutions (Miami, FL)
- …appropriate level **Responsibilities:** + Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees. + Utilizes critical ... thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and… more
- Molina Healthcare (St. Petersburg, FL)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Molina Healthcare (Tampa, FL)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in… more
- Elevance Health (Tampa, FL)
- …for ensuring regulatory compliance, operational readiness, and strategic alignment across Medicare- Medicaid integrated products. **How you will make an impact:** + ... background. **Preferred Skills, Capabilities and Experiences:** + Prior experience within Medicaid or Managed Care (MMP or DSNP) strongly preferred. + Strong… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …and processes client information to determine eligibility for Federal/State funding and Medicaid . In this role you will assist in resolving problems, locating ... Obtains and maintains appropriate eligibility documentation Completes applications for Medicaid and Federal/State Funds SSI applications, tracking and change of… more
- HCA Healthcare (Hudson, 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
- HCA Healthcare (Bradenton, 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