- 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 ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- CVS Health (Tallahassee, FL)
- …**Position Summary** The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves ... At CVS Health , we're building a world of health...role, and understanding (U&C) calculated rates and benchmarking of medical costs. The individual will be developing their role… more
- Highmark Health (Tallahassee, FL)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... audit activities. Reviews medical records to determine data quality and accuracy of...of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines.… more
- University of Miami (Medley, FL)
- …Miami/UHealth Department of Central Business Office has an exciting opportunity for a full-time Medical Biller to work in Miami, FL. The Medical Biller compiles ... completed batches to appropriate billing offices daily. + Follows up on claims submitted routinely to monitor payment status. + Transmits coded patient treatment… more
- Elevance Health (Tampa, FL)
- …coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you ... will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...advocate for themselves. The TOC team will review prior claims to address potential impact on current case management… more
- Elevance Health (Miami, FL)
- …coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you ... will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care… more
- Option Care Health (Jacksonville, FL)
- …provider, there is no limit to the growth of your career.** Option Care Health , Inc. is the largest independent home and alternate site infusion services provider in ... states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and… more
- Elevance Health (Tampa, FL)
- Carelon is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new ... the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...advocate for themselves. The TOC team will review prior claims to address potential impact on current case management… more