- Molina Healthcare (FL)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require… more
- Molina Healthcare (FL)
- …complicated claims, COB and DRG/RCC pricing). * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team… more
- Molina Healthcare (Tampa, FL)
- …of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Molina Healthcare (Miami, FL)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... Act** cases in accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the… more
- Molina Healthcare (Orlando, FL)
- …to provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday ... 8:00am- 5:00pm PST. This position included rotating weekends and holidays is required. Remote position **Essential Job Duties** * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm… more
- Molina Healthcare (FL)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and ... requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available… more
- Humana (Tallahassee, FL)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to ... include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The… more
- Insight Global (Sarasota, FL)
- …Global is seeking a candidate that can manage billing collection for Medicare account receivables, aiming to minimize outstanding accounts and maximize cash flow. ... Resolves RTP and denied claims, and maintains the electronic Medicare billing system. Coordinates and updates CM and DDE...of a UB 04 form Experience with denials and appeals Knowledge of ICD-9, ICD-10, and CPT codes Experience… more
- J&J Family of Companies (Jacksonville, FL)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals /grievances); REMs certification; Medicare and Medicaid rules and ... regulations; and state-specific clinical staff licensing / certification requirements for product administration and monitoring. + Educate staff on payer requirements, coding, billing, claim submission, and acquisition. + Share TC insights with coalition… more