- University of Miami (Miami, FL)
- …facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents that must be presented and thoroughly explained to the ... HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer… more
- Humana (Tallahassee, FL)
- …Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Understands ... **Preferred Qualifications** + Experience with SQL or VBA + Medicare experience Travel: While this is a remote position,...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Miramar, FL)
- …1 consults and collaborates with clinicians to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 1 work assignments ... to make an impact** CMS regulations, OASIS accuracy, and Medicare Conditions of Participation demand meticulous documentation. A QA...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Tampa, FL)
- …companies relative to Medicaid product implementation, operations, contract compliance , and federal contract application submissions. The Market Development ... + Bachelor's degree + 3 + years' experience with Medicaid/ Medicare /Employer Group operations/Category Management/Supplier Management + 3 +years managing large… more
- University of Miami (Miami, FL)
- …facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents that must be presented and thoroughly explained to the ... HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer… more
- Humana (Tallahassee, FL)
- …with members while concurrently navigating multiple computer applications. To ensure compliance and support the auto dialer process essential to our business, ... communication and interpersonal skills. **Duties Include** + Telephonically work with Medicare members with transitional needs and complex chronic conditions. +… more
- CenterWell (Daytona Beach, FL)
- …local primary care "on-call" program of Conviva as needed. . Assures personal compliance with licensing, certification, and accrediting bodies. . Spend 100% of your ... . New graduates will be considered . Experience managing Medicare Advantage panel of patients with understanding of Best...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- University of Miami (Miami, FL)
- …as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population preferred + Completion of Medicare annual ... between patient care services and collaborative teams. + Ensures compliance with regulatory and maintains credentialing, competencies, and professional standards… more
- Molina Healthcare (Tampa, FL)
- …BH peer reviews and appeals * Supports BH committees for quality compliance . * Implements clinical practice guidelines and medical necessity review criteria * ... Tracks all clinical programs for BH quality compliance with NCQA and CMS * Assists with the...(TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development,… more
- Cleveland Clinic (Port Saint Lucie, FL)
- …department practices and procedures for utilization review and discharge planning, ensuring compliance with managed care contracts and Medicare regulations. + ... and understanding of utilization review requirements, discharge planning process, and Medicare regulations to help ensure timely and quality patient care. **A… more