- University of Miami (Miami, FL)
- …tests the revised treatment matrix to identify possible cancers from claims data. CORE JOB FUNCTIONS Analyzes regulatory requirements, identifies potential ... maintain effective interpersonal relationships. + Ability to understand and follow instructions. Department Specifics: Facilitates the process of preparing required… more
- University of Miami (Coral Gables, FL)
- …Manages a diverse caseload from intake to resolution, ensuring timely follow -up, detailed documentation, and compliant tracking.2. Triages and escalates high-risk ... employees and assists with applications for leaves of absence, disability claims , accommodations, and internal assistance programs (eg, FSAP, mental health,… more
- Molina Healthcare (St. Petersburg, FL)
- …work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring. + Provides peer review of… more
- Elevance Health (Tampa, FL)
- …of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment ... rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management… more
- Intermountain Health (Tallahassee, FL)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... coding in an inpatient hospital setting. AND Demonstrated understanding of medical terminology, medical acronyms, anatomy and physiology. AND Demonstrated… more
- United Therapeutics (Tallahassee, FL)
- …Demonstrated knowledge of regulatory/compliance requirements including the Anti-Kickback Statute, False Claims Act, FCPA, Sunshine Act, HIPAA and other regulations + ... urgency, with high motivation and ability to take initiative, follow through and complete projects in a professional and...enthusiasm, creativity, and persistence to innovate for the unmet medical needs of our patients and to benefit our… more
- Elevance Health (Tampa, FL)
- …organizations. **How you will make an impact:** + Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network ... + Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues....you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance… more
- Elevance Health (Tampa, FL)
- …of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment ... of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management… more
- Option Care Health (Tallahassee, FL)
- …financial assistance program). + Supports the ongoing activities needed to ensure clean claims on hold and denial management ( follow -up on paperwork where ... functions. **Travel Requirements** N/A **Preferred Qualification & Interests** Previous healthcare/ medical billing experience preferred. May perform other duties as… more
- EMCOR Group (Orlando, FL)
- …between managers, clients, suppliers, and team members.** **Benefits include Family Medical Care Plan, National Electrical Benefit Fund & National Electrical Annuity ... Safety Department in performing incident and/or accident investigations and follow -up + Understands all subcontractors' scopes; assures subcontractors maintain… more