- Evolent (Tallahassee, FL)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Evolent (Tallahassee, FL)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Molina Healthcare (FL)
- …of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid , and Marketplace government -sponsored programs . * Data ... claims projects. * Evaluates claims using standard principles and applicable state -specific regulations to identify claims processing errors. * Applies claims… more
- Highmark Health (Tallahassee, FL)
- …deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act ... medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical ... processing + Perform other tasks as assigned. + Follow all applicable government regulations, including HIPAA + Comply with departmental policies regarding safety,… more
- Evolent (Tallahassee, FL)
- …future of oncology care delivery** . + Not under sanction or exclusion from Medicare/ Medicaid programs . To ensure a secure hiring process we have implemented ... within the past 2 years. + Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain). + Demonstrated **leadership in… more
- Humana (Tallahassee, FL)
- …stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and ... banking, corporate/business unit strategy, or finance + 2+ years of project/ program leadership experience + Demonstrated ability for bringing structure to ambiguity… more
- Datavant (Tallahassee, FL)
- …health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining ... + Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and...for analysis and assumptions to provide data-driven insights into program performance and partnerships + Create clear and concise… more