- Evolent (Tallahassee, FL)
- …from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services ( CMS ), Food and Drug Administration (FDA), ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...culture. **What You'll Be Doing:** **Senior Scope Analyst, Scope Management ** The Specialty Scope Management team is… more
- Molina Healthcare (St. Petersburg, FL)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Humana (Tallahassee, FL)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- BayCare Health System (Clearwater, FL)
- …| Exempt | Reimbursement Department **About the Role:** The Senior Revenue Management Analyst plays a key role in BayCare's Reimbursement department, specializing in ... the Team:** + Analyze government reimbursement data and develop strategies for Medicare /Medicaid Cost Reports + Prepare and review annual cost reports and ensure… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more
- BayCare Health System (Clearwater, FL)
- …developing leadership skills and may interact periodically with all levels of management . + This position is responsible for government payer reimbursement related ... to Medicare , Medicaid...and staying current on all government regulatory changes and CMS /Federal and State proposals to change reimbursement methodologies and… more
- Humana (Tampa, FL)
- …Bachelor's degree + 10 plus years' experience in health insurance operations, complaint management , and CMS STARs programs (experience in large national insurers ... serve as a strategic leader overseeing initiatives to improve CMS STAR ratings and manage Complaint Tracking Metrics (CTMs)...annual revenue. + Collaborate with peer leaders in Risk Management and Grievances & Appeals to implement best practices… more
- CVS Health (Tallahassee, FL)
- …vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... compliance with internal policies and procedures as well as regulatory guidance from CMS , OIG or other Regulatory body. **Required Qualifications** + Minimum of 1… more
- Intermountain Health (Tallahassee, FL)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more
- Molina Healthcare (Tampa, FL)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more