- AdventHealth (Maitland, FL)
- …Senior Compliance Analyst will have expertise in Commercial and Governmental ( Medicare , Medicaid, Tricare) payer reimbursement language and methodologies. The Senior ... spreadsheets throughout any settlement, mediation, arbitration or lawsuits. + Audit current contracts for potential revenue opportunities and contract violations… more
- Ensono (Miami, FL)
- …US Citizenship and pass related background checks including but not limited to Medicare and Medicaid and VA **Preferred Skills:** + Experience with secure file ... transfer protocols and audit /compliance requirements. + Ability to work in a hybrid...a strong background in implementing and maintaining Centers for Medicare & Medicaid Services (CMS) security standards and compliance… more
- Prime Therapeutics (Tallahassee, FL)
- …internal and external distribution Compliance Committee and the Compliance and Audit Committee and supports the Chief Compliance Officer's compliance governance ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** +… more
- Molina Healthcare (Tampa, FL)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- CHS (Clearwater, FL)
- …and audits for claims which are in excess of payment authority limits in assigned audit queues. + Listen to and view all recorded customer service calls within the ... timeliness of claims processing. + Utilize Excel, prepares tracking and trending written audit reports based on findings and communicate audit findings with… more
- CVS Health (Tallahassee, FL)
- …with heart, each and every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...International Classification of Disease (ICD) codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- TEKsystems (Tampa, FL)
- NOW HIRING FOR EXPERIENCED MEDICARE PROVIDER SERVICES REPS!! This is fully remote anywhere, but you must be able to work 8a-8pEST Monday-Friday including 1 Saturday ... is responsible for responding to all Department of Health audit calls on a consistent basis. + Acts as...and working remotely + Basic to intermediate knowledge of Medicare insurance + Familiarity with MS Office Applications (Outlook,… more
- Humana (Tallahassee, FL)
- …documented procedures/regulations/professional standards with some interpretation + Supports the Audit and Process Improvement teams by providing feedback to Care ... successfully working as a Care Manager/Care Coach/Care Coordinator/Service Coordinator in a Medicare or Medicaid market **OR** two (2) or more years of professional… more
- Prime Therapeutics (Tallahassee, FL)
- …reporting to the Corporate Compliance Committee (CCC) and Finance, Compliance & Audit Committee (FCA) meeting materials. + Act as a liaison between technical ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- Evolent (Tallahassee, FL)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... 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