- Humana (Tallahassee, FL)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- AdventHealth (Maitland, FL)
- …language as it relates to reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ... language as it relates to reimbursement methodologies + Applies detailed understanding of medical coding systems affecting the adjudication of claims to include… more
- LogixHealth (Dania Beach, FL)
- …will have strong technological skills, excellent interpersonal communication, and experience in medical billing. Key Responsibilities: + Review denials on an ... in Dania Beach, FL This Role: As a Junior Medical Billing Specialist at LogixHealth, you will work with...claims + Prepare and submit out appeals on claims that require additional review or reconsideration… more
- Molina Healthcare (FL)
- …of other insurance records and has a direct impact on medical expenses and premium reimbursement. **KNOWLEDGE/SKILLS/ABILITIES** + Provides telephone, clerical, and ... and internal COB leads. + Updates the other insurance table on the claims transactional system and COB tracking database. + Contacts CMS directly or coordinates… more
- CVS Health (Tallahassee, FL)
- …The ideal candidate will be able to work independently and with others to review claims tied to different overpayment projects in the Overpayment Tracking ... day. **Position Summary** This position will be responsible for utilizing previous ACAS claims experience along with provided guidance to review and validate … more
- Canon USA & Affiliates (Tallahassee, FL)
- …of the business unit. + Support regulatory activities by managing image quality review with external medical experts, providing clinical expertise, and reviewing ... **Mgr Medical Affairs - Clinical Development Sr - HIT...and external experts. Support marketing in developing collaterals and review of collaterals for clinical accuracy and adherence to… more
- LogixHealth (Dania Beach, FL)
- …Billing Specialist at LogixHealth, you will work with a team of fellow medical billers, administrators, and coders to provide cutting edge solutions that will ... communication, and experience in third-party billing. Key Responsibilities: + Review /work denials on an explanation of benefits (EOB) statement...A/R (Accounts Receivable) reports to follow up on unpaid claims + Send out appeals on claims … more
- Sedgwick (Orlando, FL)
- … system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate ... disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining… more
- Sedgwick (Orlando, FL)
- … system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate ... disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining… more
- Elevance Health (Tampa, FL)
- … with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Provider Auditor** conducts on-site reviews of … more