• Quality Compliance Professional

    Humana (Fort Myers, FL)
    …internal and external stakeholders. + Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (05/30/25)
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  • Director, Grievance and Appeals

    Humana (Tallahassee, FL)
    …operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (05/30/25)
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  • Risk Adjustment Compliance Professional 2

    Humana (Tallahassee, FL)
    …+ Building working relationships with internal stakeholders and supporting external audit preparation efforts. + Demonstrating an understanding of departmental and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (05/22/25)
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  • Case Manager

    Cardinal Health (Tallahassee, FL)
    …for reporting any payer issues to the appropriate team + Must self- audit activities to ensure accuracy and efficiency for the program **_Qualifications_** + ... benefit investigations, prior authorizations, and appeals, preferred + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies,… more
    Cardinal Health (05/21/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Orlando, FL)
    …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management… more
    Molina Healthcare (05/16/25)
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  • Quality Management Analyst 3 - Healthcare Data…

    University of Miami (Hialeah, FL)
    …the mandates by state and federal programs, inclusive of the Centers for Medicare and Medicaid Services. Maintains fluency of provider workflows across UHealth that ... deadlines, and critical information stays current. + Assists with preparation of audit responses related to governmental program submissions prior to submission to… more
    University of Miami (04/19/25)
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  • Revenue Integrity Clin Charge Review Analyst RN

    HCA Healthcare (Ocala, FL)
    …clinical documentation, making necessary corrections in Patient Accounting. Based on audit findings, present recommendations to Corporate and SSC Revenue Integrity ... calls, ensuring continuous education. + Possess working knowledge of Medicare guidance, inpatient/outpatient status, and observation requirements. + Knowledge of… more
    HCA Healthcare (03/22/25)
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