- Molina Healthcare (St. Petersburg, FL)
- …healthcare experience, and a deep understanding of Centers for Medicare and Medicaid Services (CMS) programs and regulations. **KNOWLEDGE/SKILLS/ABILITIES** + ... Articulate requirements into concise and clear directions for project members (Business Owners, Developers, Testers, etc.) to understand and execute + Facilitate collaboration across departments to ensure alignment and compliance + Ingenuity to gather… more
- Humana (Tampa, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- Cognizant (Tallahassee, FL)
- …billing, with strong knowledge of RARC and CARC codes. . Expertise in Medicare , Medicaid, Managed Care, and Commercial payer processes. . Deep understanding of ... federal/state billing guidelines and reimbursement methodologies. . Strong analytical and problem-solving skills to identify and resolve denial root causes. . Proficiency in Excel for data analysis and reporting. . Excellent verbal and written communication… more
- Baylor Scott & White Health (Tallahassee, FL)
- …and reporting to stakeholders across all lines of business (Commercial, DTE, Medicare , and Medicaid). Candidate will oversee extracting and analyzing medical and ... pharmacy claims data, translating output into business recommendations. This individual will design, develop, and support the creation of core analytics products, standardized across the organization. The Medical Trend Analytics Manager 1 will orchestrate… more
- Intermountain Health (Tallahassee, FL)
- …knowledge, addressing concerns promptly while maintaining a working understanding of Medicare , Medicaid, and third-party billing requirements, as well as privacy and ... confidentiality regulations. **Skills** + Customer Service + Order Entry & Processing + Communication + Interpersonal Skills + Patient Care + Referral Management + Telephone System Proficiency + Computer Literacy + Medical Equipment Knowledge + Problem Solving… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- HCA Healthcare (Ocala, FL)
- …is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as ... appropriate + Compose technical denial arguments for reconsideration, including both written and telephonically + Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument + Identify… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- Banner Health (FL)
- …and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health ... Care Financing Administration (HCFA), as well as company and applicable professional standards. 4. As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes. 5. Works independently under regular… more
- Highmark Health (Tallahassee, FL)
- …offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being ... familiar with applicable federal rules/regulations that remain consistent throughout the nation **Skills** + Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase + Excellent interpersonal, communication and attentive listening… more