- Molina Healthcare (FL)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Molina Healthcare (FL)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Molina Healthcare (Tampa, FL)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Molina Healthcare (Miami, FL)
- …**Provider No Surprise Act** cases outcomes. . * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... * At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. *… more
- Molina Healthcare (Orlando, FL)
- …* Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides training, ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal ...proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager… more
- AssistRx (Orlando, FL)
- …Patient Access Specialist : + In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage + 2 to 3 years of benefit investigation ... Day in the Life as a Bilingual Patient Access Specialist : This role works directly with healthcare providers &...(PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move… more
- AssistRx (Maitland, FL)
- …coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...patients Requirements + In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage + 2 to 3… more
- AssistRx (Maitland, FL)
- …provided for a specific pharmaceutical product. The Insurance Verification Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...In-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage. + 2 to 5… more
- HCA Healthcare (Ocala, FL)
- …experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional medical /billing, medical ... the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- BayCare Health System (Clearwater, FL)
- …+ Conduct thorough investigations by gathering relevant information, documentation, and medical records. + Triage, plan, and execute intake of Appeals ... management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. + Participate in… more