- Molina Healthcare (St. Petersburg, FL)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… 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 ... situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the… more
- CVS Health (Tallahassee, FL)
- …advocate care to assist the member with a clear path to care, claims understanding and resolution and educates the member with online resources. The Customer ... the member. + Anticipates customer needs. + Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. +… more
- AssistRx (Orlando, FL)
- …and experience. + Other skills required: + Previous work experience in Medical Reimbursement or Customer Service. + Submitting billing data to appropriate insurance ... providers + Processing claims and resolving denial instances + Achieving maximum reimbursement...for services provided + Completing Medicare and Commercial insurance claim submission. + Documenting and reporting payment information. +… more
- CenterWell (Tallahassee, FL)
- …computations. Typically works on semi-routine assignments. Job Description The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy ... claims adjudication, including method of payment, co-pay or deductible...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Herc Rentals (Bonita Springs, FL)
- …for additional assistance beyond the stated warranty period or policy. Create claims from the work orders for those failures following the manufacturers requirements ... equipment purchased by Herc. **What you will do ** + Submit warranty claims to multiple manufacturers through the manufacture's website warranty system in a timely… more
- Sedgwick (Tallahassee, FL)
- …you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your ... of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Humana (Tallahassee, FL)
- …and help us put health first** The Corporate Medical Director relies on medical background and reviews 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 about the… more
- AdventHealth (Tampa, FL)
- …Management (CM) departments and serves as a liaison between UM and CM teams and medical staff, as well as, the medical liaison for payor escalations. The ... Management, Care Management, Managed Care and Revenue Cycle departments and applicable medical staff, as well as collaborating with other disciplines to assist in… more
- Intermountain Health (Tallahassee, FL)
- …by service behavior standards + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB) + Translations + ... + Minimum of one (1) year of full cycle medical billing experience, required + Minimum of six (6)...procedures such as debits/credits, required + Experience with insurance claim appeals, required + Excellent computer skills (including Microsoft… more