- Humana (Tallahassee, FL)
- …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help ... people with Medicare , or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As… more
- Humana (Tallahassee, FL)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looking for long-term improvements of encounter submission processes. Begins to… more
- CenterWell (Deerfield Beach, FL)
- …Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five ... years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best...in a value based relationship environment . Knowledge of Medicare guidelines and coverage . Bilingual is a plus… more
- Humana (Tallahassee, FL)
- …medical review by physician or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of high quality, appropriate, and ... to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the Medicare … more
- BAYADA Home Health Care (Orlando, FL)
- …as it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations ... of MCM. + Prevent or decrease the occasion of Medicare denials by assuring proper coding on the plan...Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, Home… more
- Medical Mutual of Ohio (Fort Myers, FL)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Provides telephonic/virtual, ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind… more
- Molina Healthcare (Miami, FL)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Humana (Tallahassee, FL)
- …determining objectives and approaches to assignments. This role is within the Medicare Finance organization. This role will be required to collaborate with various ... requests and perform valuations that help inform financial strategy related to the Medicare Advantage line of business. **Use your skills to make an impact**… more
- BayCare Health System (Clearwater, FL)
- …This position is responsible for government payer reimbursement related to Medicare , Medicaid and TRICARE/CHAMPUS, specifically completion of the annual Medicare ... with at least two years direct preparation of the Medicare cost report working papers and filing of the...**Candidate should have experience in several of these areas:** Medicare bad debts; DSH (Disproportionate Share); Graduate Medical Education… more
- Humana (Tallahassee, FL)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... Strategy team plays a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's total revenue… more