- Deloitte (Tallahassee, FL)
- …vendors by reviewing services, contracts, performance guarantees, and renewals. + Analyze claims utilization data and assess health plan performance against ... Pharmacy Benefit Manager/ Health & Group Benefits Senior Consultant Human CapitalOur...plan offerings and design. + Manage RFP processes for medical , dental, pharmacy, life, and disability programs, including development,… 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
- Molina Healthcare (Tampa, FL)
- …+ Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Sedgwick (Miami, FL)
- …General Adjuster - Southeast Region **PRIMARY PURPOSE** **:** To handle losses or claims nationally regardless of size, including having the ability to address any ... Account. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine insurance coverage. + Administers… more
- University of Miami (Medley, FL)
- …The University of Miami/UHealth Central Business Office has exciting Full-Time Senior Medical Biller opportunities work remotely. The Senior Medical Biller ... on accounts and monitors to keep the contents at a minimum. + Verifies all claims and ensures edits are collected and released in a timely fashion. + Reports edits… 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
- Aveanna Healthcare (Miami, FL)
- Home Health RN Executive Director of Operations ApplyRefer a FriendBack Job Details Requisition #: 207426 Location: Miami, FL 33166 Category: Nursing Salary: ... maintaining compliance with all Federal and State regulations governing Home Health Care Agencies, and ensuring compliance with Aveanna's policies and procedures.… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …MCG(R) screening criteria. Responsibilities: + Manages appropriate cases that require medical necessity review such as home care, elective inpatient and outpatient ... requests. + Reviews cases referred by the prior-authorization non-clinical medical management coordinator and pre-certification technician staff according to member… 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
- 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 ...exposure to benefits and/or contract interpretation, including experience with claims systems and network databases. + 3-5 years of… more