- AdventHealth (Maitland, FL)
- …as it relates to reimbursement methodologies + Applies significant understanding of medical coding systems affecting the adjudication of claims to include ... quantify, and present contract compliance violations. He/she will perform extensive review of contract language, state and federal regulations, and payor practices… more
- Butterfly Effects (Deerfield Beach, FL)
- …and resolve billing errors to reduce claim denials. + Correct and resubmit denied claims for billing errors. + Review and address immediate rejections from the ... makes a difference! Butterfly Effects is looking for a Medical Billing Specialist to support our national billing needs....national billing needs. In this role, you'll ensure clean claims and accurate submissions, allowing our field teams to… more
- Elevance Health (Tampa, FL)
- …+ Serves as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company ... fee for service and assisting nurses as needed with review of claims . Works with other Medicare...claims . Works with other Medicare Administrative Contractor (MAC) Medical Directors for developing collaborative policies. May participate in… more
- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Sedgwick (Tallahassee, FL)
- …you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your ... of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Humana (Tallahassee, FL)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + ... Coding Educator is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with providers to enhance… more
- CVS Health (Tallahassee, FL)
- …improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims . You will be a key link in providing our ... and screens to obtain and record claim information + Review claims information to determine the nature...willingly to change, and a positive, willing attitude. Prior medical claim processing experience is a plus. Successful candidates… more
- Molina Healthcare (FL)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. +… more
- Fujifilm (Tallahassee, FL)
- …be an integral part of the legal team providing support to the Medical Device businesses of FUJIFILM Healthcare Americas Corporation and FUJIFILM SonoSite, Inc., ... (HLUS). The Senior Counsel, reporting to the Division General Counsel, Medical Devices, will be an experienced commercial transactions lawyer, responsible for… more