- Molina Healthcare (FL)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Molina Healthcare (FL)
- …Affairs to assess and provide analyses for proposed changes to Medicare , and other government-sponsored healthcare program contracts, governing regulations and new ... 10 years' experience in Managed Care, specifically government programs and/or Medicare /Duals Health Plan Operations or equivalent combination of education and… more
- Molina Healthcare (St. Petersburg, FL)
- …related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM ... portal, SLA tracking, and program audits. * Deep knowledge of Medicare regulations affecting complaints, grievances, and member communications. * Exposure to… more
- Humana (Tallahassee, FL)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Insight Global (Orlando, FL)
- …Diploma/GED 5+ years Backend Reimbursement experience Cost reporting experience for Medicare /Medicaid Appeals Experience filing state surveys + external reviews such ... Diploma/GED 5+ years Backend Reimbursement experience Cost reporting experience for Medicare /Medicaid Appeals Experience filing state surveys + external reviews such… more
- Molina Healthcare (St. Petersburg, FL)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including… more
- Molina Healthcare (Jacksonville, FL)
- …or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:** ... Associate's Degree and/or equivalent combination of education and Health Care related experience of 4+ years **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 4+ years experience in health care industry in related field **PREFERRED EDUCATION:** Bachelor's… more
- Molina Healthcare (St. Petersburg, FL)
- …speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is ... present at all times of operation. + Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. + Responsible for key performance indicators (KPI) reporting to… more
- Molina Healthcare (Orlando, FL)
- …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more