- Molina Healthcare (FL)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... excellent problem-solving skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting,… more
- Prime Therapeutics (Tallahassee, FL)
- …Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible ... + Previous leadership/people management experience + PBM/health care experience + Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare… more
- Molina Healthcare (Tampa, FL)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... Any one or more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + … more
- Highmark Health (Tallahassee, FL)
- …or CERTIFICATIONS** **Required** + None **Preferred** **(Any of the Following)** + Certified Public Accountant (CPA) + Certified Internal Auditor (CIA) + ... Certified Fraud Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified ...and cross-functional strategy development. + Experience with managed care, Medicare and federal and/or state regulations, quality improvement and… 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 ... Credentials (Inpatient or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): … more
- Evolent (Tallahassee, FL)
- …from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and ... such as: + Registered Health Information Technician (RHIT) + Certified Hematology and Oncology Coder (CHONC) + Certified... Certified Hematology and Oncology Coder (CHONC) + Certified Coding Associate (CCA) + Certified Professional… more
- Sedgwick (Tallahassee, FL)
- …achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work(R) Fortune Best Workplaces in ... limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests… more
- Evolent (Tallahassee, FL)
- …and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great Places to Work" in 2021. In 2020 and 2021 Evolent in ... 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
- Actalent (Orlando, FL)
- …determination. Responsibilities + Process and manage denied prior authorization requests for Medicare and Medicaid patients. + Make 30-60 outbound calls per shift to ... Medicare members, primarily elderly individuals, regarding denied medication requests....member calls with professionalism and empathy. Essential Skills + Certified Pharmacy Technician (CPhT). + Experience in pharmacy operations,… more
- Actalent (Orlando, FL)
- …Technician to join our team. In this role, you will primarily support Medicare and Medicaid patients by managing the intake and processing of prior authorizations. ... and complete processing. + Manage intake of prior authorizations, primarily for Medicare and Medicaid patients. + Maintain accurate records and documentation for all… more