- Highmark Health (Tallahassee, FL)
- …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- Intermountain Health (Tallahassee, FL)
- …Requirements* Workflow Process* Communication* Insurance Processing and Issues* Medical Terminology* Claims Processing* Collaboration* Time Management* ... Workflow Process + Communication + Insurance Processing and Issues + Medical Terminology + Claims Processing + Collaboration + Time Management + Team Building… more
- AdventHealth (Maitland, FL)
- …as it relates to reimbursement methodologies + Applies significant understanding of medical coding systems affecting the adjudication of claims to include ... damages calculations, and organizing data/materials from other AdventHealth departments (ie medical records, itemized bills, etc.) within the scheduled timeframes. +… more
- Elevance Health (Tampa, FL)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... works with one provider type, eg physician, ancillary, or medical group. Provides advice and analytic support to ...and specialty care procedures and recommends policy changes and claim 's system changes to pursue cost savings. + Reviews… more
- CVS Health (Tallahassee, FL)
- …measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical ... 2+ years of experience working with diagnosis codes and medical terminology. + Moderate to advanced knowledge of Excel...and decision making skills + College degree preferred + Claims experience + DG experience **Education** + High School… more
- Cognizant (Tallahassee, FL)
- …Interpret paper contracts for reimbursement. . Troubleshoot and remediate/workaround for claim pend issues. . QNXT Configuration for New implementation and existing ... groups, fee tables, policy admin, etc. . Troubleshoot and remediate/workaround for claim pend issues. . QNXT and NetworX Configuration for different State… more
- Humana (Tallahassee, FL)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Fujifilm (Tallahassee, FL)
- …be an integral part of the legal team providing support to the Medical Device businesses of FUJIFILM Healthcare Americas Corporation and FUJIFILM SonoSite, Inc., ... (HLUS). The Senior Counsel, reporting to the Division General Counsel, Medical Devices, will be an experienced commercial transactions lawyer, responsible for… more
- Centene Corporation (Tallahassee, FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... evaluation of variable factors. Candidate must have valid Florida Medical license and must be able to start with...able to start with 30-60 days of hire. The Medical Director actively uses their medical background,… more