- Molina Healthcare (Jacksonville, FL)
- …to meet critical needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case ... methodologies for programs, develops and coordinates implementation of business strategy + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent… more
- Cognizant (Tallahassee, FL)
- …and member onboarding for individual, group, and government-sponsored health plans ( Medicare , Medicaid, ACA), ensuring compliance with CMS, ACA, and ... Sales & Enrollment team and work collaboratively with business stakeholders, sales, marketing, compliance , IT, and clients. **In this role, you will:** * Define and… more
- Prime Therapeutics (Tallahassee, FL)
- …insurance/PBM operations and/or contract audit experience + Experience with regulatory compliance for Medicare /Medicaid/Commercial or ACA drug benefit + Project ... accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is… more
- CenterWell (Tampa, FL)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical… more
- CenterWell (Lake City, FL)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical… more
- Elevance Health (Altamonte Springs, FL)
- …programs. + Processes prior authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all ... prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. + Generates reports relating to rebates, physician… more
- Elevance Health (Pembroke Pines, FL)
- …programs. + Processes prior authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all ... prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. + Generates reports relating to rebates, physician… more
- Prime Therapeutics (Tallahassee, FL)
- …fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The ... Compliance Principal is responsible for supporting Oversight and Monitoring...or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Prime Therapeutics (Tallahassee, FL)
- …Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst (Regulatory Change Management) - Remote **Job Description** The Senior ... Compliance Analyst assists in the implementation of Prime's ...organization, or other highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) Must… more
- Prime Therapeutics (Tallahassee, FL)
- …Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** The Senior Compliance Analyst assists ... designated areas. This role partners with key internal stakeholders to execute compliance program and compliance department activities related to demonstrating … more