- 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
- Highmark Health (Tallahassee, FL)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- AssistRx (Orlando, FL)
- …frameworks. Cross-Functional Collaboration + Partner with Product, Marketing, Client Services, Compliance , and Data teams to forecast impact and align strategy with ... and assessing federal or state health policy (eg, CMS, Medicaid, Medicare , ACA, drug-pricing legislation). + Strong understanding of US healthcare delivery,… more
- BayCare Health System (Clearwater, FL)
- …position within your area of specialty, ensuring the integrity of financial reporting and compliance with CMS guidelines. You will play a key part in preparing cost ... You'll Do In the Role:** + Prepare and analyze Medicare and Medicaid Cost Reports for multiple facilities to...and Medicaid Cost Reports for multiple facilities to ensure compliance with CMS regulations. + Perform rate modeling for… more
- Humana (Tallahassee, FL)
- …clearly-especially around generative AI. Design for scalability, reliability, and compliance . + **MLOps & DevOps Collaboration** Work with engineering and ... + **Industry Knowledge** : Familiarity with the healthcare sector, specifically Medicare Advantage, and an understanding of regulatory frameworks and market… more
- Humana (Tallahassee, FL)
- …together solution architects, product owners, engineering teams, operations and compliance stakeholders to ensure seamless, secure, and scalable integrations. This ... Success looks like faster time-to-launch, high client satisfaction, audit-ready compliance , and repeatable, scalable patterns. What you bring: healthcare/pharmacy… more
- Aveanna Healthcare (Naples, FL)
- …Collier county Essential Job Functions + Deliver quality patient care in compliance with physician orders under direction of their Registered Nurse teammate. * ... application + Valid CPR and Drivers License Preferred: + Medicare Skilled Nursing experience + Basic understanding of Oasis...Home Base exp a plus As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
- Humana (Tallahassee, FL)
- …cross-functionally with market leadership, accounting, actuarial, clinical, operations, and Medicare counterpart teams. + Work closely with market actuaries; assist ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- University of Miami (Miami, FL)
- …related to pathology, laboratory, and state/ federal regulations. Oversees the Medicare Secondary Payer Questionnaire (MSPQ) process in accordance with Centers for ... Medicare & Medicaid Services (CMS) Federal regulations. + Reviews...procedures related to the laboratory accessioners and continuously monitors compliance . + Monitors slide flow and communicates to Manager… more
- TEKsystems (Orlando, FL)
- …* Document all patient interactions accurately and escalate clinical or compliance concerns to pharmacists or supervisors * Provide exceptional customer support ... registration, prior authorization, inbound call, administrative support, customer service, medicare , medicaid Top Skills Details insurance claim,call center,insurance verification,health… more