- Molina Healthcare (St. Petersburg, FL)
- …for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare , and Marketplace lines of business. This includes direct management ... to support efficient and compliant subrogation operations across Medicaid, Medicare , and Marketplace populations. + Collaborate with legal, claims, provider… more
- CVS Health (Tallahassee, FL)
- …records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... record documentation review, diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more
- Elevance Health (Tampa, FL)
- …equivalent background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services ( CMS ) and Affordable Care Act (ACA) ... has experience working in leading healthcare payer claims/ revenue cycle management (RCM) organizations, with specific understanding in end-to-end claims/ encounter… more
- Highmark Health (Tallahassee, FL)
- …leadership, problem-solving, data analytics, team development, communication, implementation, and project management . The incumbent often plays a central role in the ... include elements of team leadership, problem-solving, data analysis, project management , communication, implementation, and provider and/or provider-facing team education… more
- University of Miami (Fort Lauderdale, FL)
- …collects funds. + Maintains appropriate records, files, and accurate documentation in the system of record. + Serves as a lead resource for lower-level Patient ... Services staff. Recommends new approaches to management for enhancing performance and productivity. + Deploys critical...HIPAA, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance, ABNs, and MSPQ, prior to services being… more
- AdventHealth (Orlando, FL)
- …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
- Highmark Health (Tallahassee, FL)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior authorization, dose and… more
- Fresenius Medical Center (Lakeland, FL)
- …material assist devices for the heavier items. **EDUCATION** + Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification or High ... testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . + Ensure that all...+ Inventory for Patients + Assists patient with supply management and contacting customer service **PHYSICAL DEMANDS AND WORKING… more
- Molina Healthcare (St. Petersburg, FL)
- …and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- HCA Healthcare (Orange Park, FL)
- …Advice + Payer denial/DRG downgrade letters + Complex NCD/LCD guidelines, CMS /AHCA policies and regulations + Federal Register, Center for Medicare ... Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites + Escalates problem… more