- Elevance Health (Tampa, FL)
- … chart coding principles, clinical guidelines and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement… 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
- Molina Healthcare (Jacksonville, FL)
- …contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles ... and validating source data needed to build chart retrieval chase lists for medical record collection. Success in this role requires a blend of strong technical… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …ready, oversee clinical trial and submission support, lead the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity. ... sites, and vendors (including contract research organizations) and ensure that audit results are communicated, and appropriate corrective actions are implemented and… 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
- Sedgwick (Tallahassee, 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
- City of Coral Gables, FL (Coral Gables, FL)
- …and supports overall risk-management activities. The role manages workers' compensation claims from first report through closure, partners with internal stakeholders ... and contractual insurance requirements and assists with all risk related liability claims . Job Duties and Responsibilities The following duties are normal for this… 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
- Dycom (West Palm Beach, FL)
- …+ Paid Time Off, Parental Leave, and Holidays + Insurance (including medical , prescription drug, dental, vision, disability, life insurance) + 401(k) w/ Company ... as the primary contact for the annual sustainability data audit with external audit firms + Serve...information and analyze for accuracy + Work with Dycom claims , TPA, broker and insurer to put together, analyze… 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