- Molina Healthcare (Tampa, FL)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Humana (Tallahassee, FL)
- …2+ years of actuarial experience in healthcare + SAS or other coding skills + Medicare experience + Familiarity with CMS Star Ratings Travel: While this is a remote ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Tallahassee, FL)
- …Qualifications** + Pharmacist + 7-10 years work experience in healthcare + Medicare and/or Medicare -Medicaid Integrated Product Experience + Experience with Part ... D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making… more
- USAA (Tampa, FL)
- …brokered products including Final Expense, Universal Life Insurance, Medicare Advantage & Prescription Drug Plans. Coordinates training/onboarding/development of ... NY Regulation 187, NY Reg 60, Best Interest, and CMS (Centers of Medicare and Medicaid Services). + Ability to complete AHIP (America's Health Insurance Plans)… more
- USAA (Tampa, FL)
- …a keen focus on financial risks associated with health products, especially Medicare Supplement offerings. This position is essential for safeguarding the integrity ... leading all aspects of financial risk associated with Health products, particularly Medicare Supplement + US military experience through military service or a… more
- University of Miami (Miami, FL)
- …as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population preferred + Completion of Medicare annual ... wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition Category (HCC) - review and recertification preferred + Physical presence required at all GIM sites + Conducts or… more
- ChenMed (Miami, FL)
- …+ Strong business acumen and acuity + In depth knowledge of Medicare , Medicaid, and commercial billing rules and regulations, coding, and reimbursement processes ... + Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service. + Knowledge of applicable federal, state,… more
- AdventHealth (Orlando, FL)
- …record, applying appropriate ICD-10-CM/PCS coding conventions and MS-DRG Medicare Prospective Payment System requirements. Actively participates in outstanding ... ICD-10-CM rules and conventions, coding policy and procedures, requirements of Medicare / payer specifications, and official coding guidelines as outlined by… more
- Humana (Tallahassee, FL)
- …English/Spanish + Bilingual English/Creole + Experience working with Medicare and Medicaid **Additional Information** **Work-At-Home Requirements:** To ensure ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- AdventHealth (Altamonte Springs, FL)
- …from the work of this committee are required to receive Medicare reimbursement for the organization. Responsible for developing Institute accreditation vision, ... forecast upcoming regulatory and public-reporting trends such as Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing, Agency for Healthcare… more