- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...two years related experience + Healthcare industry knowledge + Medical billing experience Benefits at LogixHealth: We offer a… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and Payment Integrity monitoring activities + Collaborate with other departments such as Claims , Medical Management, Internal Audit , Recovery and Legal teams ... with regulatory requirements + Maintain process integrity and ensure legitimate claims are processed efficiently + Implement and track corrective action plans… more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...Examiner queues waiting to be adjudicated, and in either audit or needing approval status. * Developing and implementing… more
- CHS (Clearwater, FL)
- … and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer ... Duties and Responsibilities:** + In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims … more
- Lincoln Financial (Tallahassee, FL)
- …experience. + Effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims ... multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will analyze… more
- Sedgwick (Tallahassee, FL)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Leader - Liability **PRIMARY PURPOSE** : To...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Cardinal Health (Tallahassee, FL)
- … medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles ... detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation… more
- CVS Health (Tallahassee, FL)
- …all with heart, each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- Molina Healthcare (FL)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is ... claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and...to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of… more
- Molina Healthcare (Tampa, FL)
- …to providers. **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, ... documentation for denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical… more