- Molina Healthcare (Tampa, FL)
- …and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare providers ... and Medicare programs as well as Marketplace + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems +… more
- Humana (Miramar, FL)
- …Auditor ensures clinical documentation meets CMS regulations, OASIS accuracy, and Medicare Conditions of Participation. This role audits Start of Care, ... for compliance, accuracy, and completeness, helping reduce audit risk and billing delays. The auditor monitors QA metrics, identifies trends, and collaborates… more
- BayCare Health System (Largo, FL)
- …and quantities are utilized for billing . + Verify patient eligibility for Medicare billing for drugs, requests authorization based on HCPC units for each ... Graduate or Equivalent GED + 3 years of Infusion Billing + In-depth knowledge of coverage issues with respect...all aspects of your life and career goals. + Medical benefits (Health, Dental, Vision) + Paid time off… more
- Humana (Tallahassee, FL)
- …Principal coordinates, implements, and manages oversight of the company's Medicare /Medicaid Stars Program for aligned areas. The Stars Improvement Principal ... Operations encompasses critical functions including care coordination, quality measurement, billing , claims processing, and customer service, each essential to… more
- Centene Corporation (Tallahassee, FL)
- …& Abuse:** Experience in fraud/waste/abuse identification and investigation, provider billing , or clinical coding preferred; Experience with data mining, machine ... health, and statistical modeling preferred **Quality:** Experience with HEDIS, NCQA, Medicare Star Rating System, QRS, or other quality measures preferred; Quality… more
- Cardinal Health (Tallahassee, FL)
- …in related field, or equivalent work experience, preferred + Knowledge of insurance billing , Medicare claims, and audit processes. + Familiarity with healthcare ... to work independently and collaboratively. **_Responsibilities_** + Prepare, review, and submit medical documentation and billing data to insurance providers. +… more
- Molina Healthcare (FL)
- …* Customer/provider experience in a managed care organization (Medicaid, Medicare , Marketplace and/or other government-sponsored program), or medical ... the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am -...related vocational program in health care (ie, certified coder, billing , or medical assistant). To all current… more
- Molina Healthcare (Miami, FL)
- …* Customer/provider experience in a managed care organization (Medicaid, Medicare , Marketplace and/or other government-sponsored program), or medical ... accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** *...related vocational program in health care (ie, certified coder, billing , or medical assistant). To all current… more
- Molina Healthcare (FL)
- …* Customer/provider experience in a managed care organization (Medicaid, Medicare , Marketplace and/or other government-sponsored program), or medical ... the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** *...related vocational program in health care (ie, certified coder, billing , or medical assistant). To all current… more
- HCA Healthcare (Ocala, FL)
- …accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical / billing , medical payment posting, and/or cash ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more