• Clinical Reviewer

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …including clinical records, itemized bills, prior authorizations, concurrent review, coding guidelines and provider compensation to determine appropriateness of ... medical necessity and coverage + Reference MCG guidelines, LCD/NCD's...as appl icable industry-based standards + Clinical experience within an acute care setting + Comprehensive understanding of the… more
    DOCTORS HEALTHCARE PLANS, INC. (07/16/25)
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  • OPA Health Care Programs

    University of Miami (FL)
    …lecturer positions. Applications for OPA Health Care Certificate Programs in the areas of Medical Billing and Coding , Electronic Medical Records, Hospice ... Teamwork (DIRECCT) the U community works together to create an environment driven by purpose, excellence, community, and service....indicating their expertise and experience in the areas of Medical Billing and Coding , Electronic… more
    University of Miami (07/16/25)
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  • Physician Advisor

    AdventHealth (Orlando, FL)
    …providers), and acts as the interdepartmental liaison for program development. Educate medical staff on correlation between clinical language, coding guidelines, ... mortality and DRG assignments. Attend departmental meetings to teach medical staff about coding and documentation improvement...Board certified and eligible for membership on the hospital medical staff This facility is an equal… more
    AdventHealth (05/15/25)
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  • AR Insurance Collector - Medicaid

    Cardinal Health (Doral, FL)
    …for denial or reduced payment. + Document all collection activities in the billing system according to departmental procedures. + Follow up on unpaid claims within ... payer-specific guidelines and timelines. + Coordinate with other billing team members, coders, and providers to resolve claim discrepancies. + Maintain up-to-date… more
    Cardinal Health (06/19/25)
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  • Trauma Data Abstractor

    HCA Healthcare (Pensacola, FL)
    **Description** **Introduction** Do you want to join an organization that invests in you as a( an ) Trauma Data Abstractor? At Work from Home, you come first. HCA ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...location._** You contribute to our success. Every role has an impact on our patients' lives and you have… more
    HCA Healthcare (07/19/25)
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  • Practice Transformation Associate

    CVS Health (Tallahassee, FL)
    …with your market + Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding , Medicaid risk adjustment methodology, and common billing and common ... analyzing and sharing provider performance metrics related to quality, clinical outcomes, coding , and utilization used to support ABH programs. They will be a… more
    CVS Health (07/12/25)
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  • Regional Compliance Officer AdventHealth…

    AdventHealth (Altamonte Springs, FL)
    …limited to: general compliance, privacy, conflicts of interest, physician contracting, billing / coding , and regulatory matters. Implement the AdventHealth Work ... or higher-level degree in related field This facility is an equal opportunity employer and complies with federal, state...**Shift:** 1 - Day **Req ID:** 25025717 We are an equal opportunity employer and do not tolerate discrimination… more
    AdventHealth (07/08/25)
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  • Claims and Call Auditor (Call Center QC)

    CHS (Clearwater, FL)
    …experience is preferred + Knowledge of medical terminology + Knowledge of medical coding systems + Knowledge of Medicaid/Medicare Guidelines + Knowledge of ... Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer service calls to ensure validity, accuracy, and… more
    CHS (06/14/25)
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  • Field Reimbursement Manager - West Region

    Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
    …in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing , and coding in rare disease + Strong knowledge of ... matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements + Analyze payer criteria and provide product access… more
    Otsuka America Pharmaceutical Inc. (05/23/25)
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  • Business Office Specialist

    HCA Healthcare (Brandon, FL)
    …for billing , cash posting, chart preparation, collections, insurance verification, medical records, patient registration and scheduling. **What you will do:** + ... billing , chart preparation, cash posting, collections, insurance verification, medical records, patient registration and scheduling + Be responsible for… more
    HCA Healthcare (07/16/25)
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