- 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 ... reporting. . Excellent verbal and written communication skills for documentation and appeals . . Ability to meet productivity and quality standards in a fast-paced… 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 ... preferred, such as accounts receivable follow-up, insurance follow-up and appeals , insurance posting, professional medical/billing, medical payment posting, and/or… more
- Highmark Health (Tallahassee, FL)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. + ... 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… more
- MyFlorida (Largo, FL)
- …receivables functions to maintain the billing. + Process monthly billing for all Medicare A&B, Medicaid, Medicaid Managed Care, Third Party Insurers, and any other ... needed. + File all inquiries including but not limited to reconsiderations, appeals , patient liability amounts, eligibility, and clerical re-openings. + Monitor all… more
- Molina Healthcare (Jacksonville, FL)
- …* Provides second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance. * Implements ... compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation… more
- Cardinal Health (Doral, 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
- Elevance Health (Tampa, FL)
- …weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare . + Participate in the pharmaceutical care management process through ... resolve issues related to member/provider complaints, claims processing issues and appeals . **Minimum requirements:** + PharmD from an accredited school of pharmacy… more
- Elevance Health (Pembroke Pines, FL)
- …authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations. ... + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription… more
- Baylor Scott & White Health (Tallahassee, FL)
- …leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit activities and key contract enforcement activities. + Collaborates ... (CBS) and other revenue cycle departments to streamline referral and appeals workflows. + Supports education and training initiatives to improve documentation… more