- 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 ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- HCA Healthcare (Panama City, FL)
- …our Medical Necessity Coding Compliance Coordinator opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. ... **Introduction** Do you have the career opportunities as a Medical Necessity Coding Compliance Coordinator you want with your...you will do in this role:** + Coordinate NCD/LCD/LCA review process at the Division level + Determine whether… more
- University of Miami (Medley, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Office has an exciting opportunity for a full-time Sr. Medical Biller to work in Miami, FL. The Senior...keep the contents at a minimum. + Verifies all claims and ensures edits are collected and released in… more
- Elevance Health (Miami, FL)
- …to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to ... nursing and/or medical staff for review . + The grievance...Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's… more
- Molina Healthcare (St. Petersburg, FL)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates...by the department. + Apply contract language, benefits, and review of covered services + Responsible for contacting the… more
- MyFlorida (St. Petersburg, FL)
- …Medicaid/insurance payments as assigned. + Generates Pending by Insurance report weekly to review claims submitted over 30 days without payment to determine the ... + Generates daily Bill File Creation (BFC), submits clean claims to the appropriate Clearinghouse, (electronically and/or paper ...Conducts Random Quarterly Cashier Audits + Assists with billing medical and dental services in HMS as needed. +… more
- Elevance Health (Tampa, FL)
- …coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement ... The **DRG CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims...issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record… more
- Walgreens (St. Petersburg, FL)
- …for billing is completed and accurate prior to claim submission (ie, medical claims billing). + Process reimbursement checks/payment in accordance with ... + Ensure all Medicare documentation is received from the medical provider and submitted to Danville. + Review...with Walgreens. + Experience in processes related to submitting medical claims , including but not limited to… more
- HUB International (Gainesville, FL)
- …organization. We offer: + Competitive salaries and benefits offerings + Medical /dental/vision insurance and voluntary insurance options + Health Savings Account ... + Complete comparisons, benefit/cost analysis and reports for advisor's and team's review and discussion per established procedures and practice. + Policy data… more
- University of Miami (Medley, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Central Business Office has an exciting opportunity for a full-time Supervisor, Medical Collections (H) to work in Miami, FL. The Supervisor, Medical… more