- CHS (Clearwater, FL)
- **Overview** ** ** **Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... + Knowledge of medical coding systems + Knowledge of Medicaid/ Medicare Guidelines + Knowledge of billing rules and regulations....to thirty (30) pounds. ** ** **Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** **… more
- AdventHealth (Tampa, FL)
- …cancer and other diseases. **The role you'll contribute:** The Coding Quality Auditor , under the general supervision of the Outpatient Coding Manager, is responsible ... for the internal coding audit and clinical quality reviews. The Coding Quality Auditor will work in conjunction with the Outpatient Operations Manager to ensure the… more
- AdventHealth (Tampa, FL)
- …Center. **The ro** **le you'll contribute:** The Inpatient Coding Quality Auditor , under general supervision of the Inpatient Operations Manager, is responsible ... the daily auditing of records. The Inpatient Coding Quality Auditor works in collaboration with the Manager to ensure...applicable to AdventHealth West Florida Division and requirements of Medicare and payor specifications. . Assign DRGs on chart… more
- Highmark Health (Tallahassee, FL)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician coding and/or… more
- Datavant (Tallahassee, FL)
- …educational and life experiences to realize our bold vision for healthcare. As an Auditor , HCC Risk Adjustment Coder, you will review medical records to identify and ... + Proficient in ICD-10 coding. + Experienced in HCC coding across Medicare , commercial, and Medicaid sectors. + In-depth knowledge of medical terminology,… more
- Humana (Tallahassee, FL)
- …experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Molina Healthcare (Miami, FL)
- …and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment ... data * Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy * Identify opportunities for data mining to ensure data gaps are minimized * Apply best practices to ensure accuracy of… more
- AdventHealth (Altamonte Springs, FL)
- …activities. These activities include preparation and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and ... of proposed operational decisions; and serves as subject matter resource for Medicare and Medicaid reimbursement matters. The Director is responsible for creating a… more
- Elevance Health (Tampa, FL)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... programs. The **Audit and Reimbursement II** will support our Medicare Administrative Contract (MAC) with the federal government (The...on cost report audits, may serve as an in-charge auditor on less complex audits Dependent upon experience, may… more
- NHS Management, LLC (Daytona Beach, FL)
- …other business office related tasks, including but not limited to: + Medicaid, Medicare and/or secondary billing + Assist with evaluation and selection of all ... required by Administrator, Financial Specialists, Financial Specialist Consultants, Internal Auditor , or any other corporate or regulatory compliance consultant.… more