- Adecco US, Inc. (Orlando, FL)
- …guidance on benefit investigations, prior authorizations, claims resolution, and appeals . This client- and customer-facing role requires strong relationship-building ... cases by overseeing benefit investigations, prior authorizations, claims escalations, and appeals , ensuring timely patient access. 3. Design and deliver advanced… more
- Molina Healthcare (St. Petersburg, FL)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- MyFlorida (Marianna, FL)
- …only $180 per month. + Participate in FICA social security and Medicare . (mandatory) + Workers Compensation (mandatory) + Unemployment Compensation (mandatory) + ... as directed by the Director of Pro Bono and Appeals or the Circuit Director. + Responsible for developing...in collaboration with the office of Pro Bono and Appeals , a continuous flow of qualified, prospective volunteer and… more
- Actalent (Miami, FL)
- …determination. Responsibilities + Process and manage denied prior authorization requests for Medicare and Medicaid patients. + Make 30-60 outbound calls per shift to ... Medicare members, primarily elderly individuals, regarding denied medication requests....submitted documentation and gather additional information to support the appeals process. + Forward completed cases to pharmacists for… more
- J&J Family of Companies (West Palm Beach, FL)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- J&J Family of Companies (Jacksonville, FL)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible ... management information accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to patient admission/safe… more
- Humana (Tallahassee, FL)
- …includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical… more
- Cardinal Health (Tallahassee, FL)
- …+ Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Cell/Gene therapy and/or Oncology experience, preferred +… more
- MyFlorida (Tallahassee, FL)
- …provider enrollment. The incumbent in this position shall remain informed about Medicare and other federal and state health care related programs, including other ... both state and national levels; maintain detailed knowledge of Medicare and other health care program cost reimbursement principles...of necessary procedures and forms for responding to provider appeals relating to the LIP, DSH, IME, DPP, and… more