- Elevance Health (Miami, FL)
- …Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities. + Draws on extremely advanced ICD-10 coding ... including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit...environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Elevance Health (FL)
- … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sedgwick (Tallahassee, FL)
- …work restrictions/accommodations. + Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate ... the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Highmark Health (Tallahassee, FL)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Sedgwick (Tallahassee, FL)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- MyFlorida (Orlando, FL)
- …excel in this position. The selected candidate will: + Examine and audit purchase and sales documents including receipts, invoices, business records, and related ... information entered into database(s) to assure relevancy and comprehensiveness of input for audit and enforcement purposes. + Consult with or assist taxpayers in the… more
- Sedgwick (Jacksonville, FL)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Highmark Health (Tallahassee, FL)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Wolters Kluwer (Tampa, FL)
- …platforms. In addition, during heavy periods of incoming invoice volume, conduct the initial audit and/or quality assurance invoice review audit up to 15% of the ... prior supervisory experience, preferably in a legal billing or claims environment. + 5+ years' experience in the legal...and to exercise discretion and sound judgment when making audit and adjustment decisions. + Understanding of legal terminology… more
- Highmark Health (Tallahassee, FL)
- …or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated funds paid ... for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into… more