- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . . No history of disciplinary or legal action… more
- Evolent (Tallahassee, FL)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Evolent (Tallahassee, FL)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- HCA Healthcare (Orange Park, FL)
- …The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain ... guidelines, CMS/AHCA policies and regulations + Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug… more
- TEKsystems (Tampa, FL)
- …and report documentation trends, coding errors, or compliance risks. * Assist with appeals and denials related to coding or medical necessity. * Maintain current ... surgery. * Strong understanding of CPT guidelines for outpatient surgery and Medicare 's ASC payment system. Skills Surgical Coder, Surgical Coding, ASC, Ambulatory… more
- Humana (Tallahassee, FL)
- …revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices and ensure timely, equitable resolution of issues. ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Cardinal Health (Tallahassee, FL)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- Cardinal Health (Tallahassee, FL)
- …industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint, ... with long- and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial plans while planning for various… more
- Trinity Health (Fort Lauderdale, FL)
- …abstracts data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines. Ensure medical documentation and coding compliance with Federal, ... Business Service (PBS) centers, including analysis of clinical documentation, assisting in appeals , root cause analysis and tracking as needed. 6. Educates clinical… more