- Molina Healthcare (Miami, FL)
- …including hospital acute care/ medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** + ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data… more
- Travelers Insurance Company (Tampa, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... negotiating and resolving assigned Construction Defect and Latent Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Travelers Insurance Company (Orlando, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... negotiating and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… 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
- Molina Healthcare (Orlando, 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
- Sedgwick (Tallahassee, FL)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Crisis Care Triage **This nurse will need to be on call every Saturday 6am until Monday 6am each ... injury referral calls from clients; gathers vital case details, obtains and provides medical status updates to the customer, and assigns a Field Case Manager (FCM)… more
- ZOLL Medical Corporation (Melbourne, FL)
- …innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and ... as well as support activities to promote consistent use (Local Medical Education Programs, Tradeshows, clinical symposiums and conferences). Call points include:… more
- Elevance Health (Tampa, FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... claims . **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more
- Zelis (St. Petersburg, FL)
- …Claim Review. They will be responsible for reviewing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence to proper coding and ... as it relates to the Itemized Bill Review product, analyzing inpatient DRG claims based on industry standard inpatient coding guidelines, and supporting the Office… more
- AdventHealth (Altamonte Springs, FL)
- …and evaluating) and primary nursing principles. The Employee Health Registered Nurse also oversees Workers' Compensation claims , hospital surveillance programs, ... Springs, FL 32714 **The role you'll contribute:** The Employee Health Registered Nurse for the Employee Clinic collaborates closely with the Employee Clinic Manager,… more