• Investigator, Special Investigative Unit - FLORIDA

    Molina Healthcare (FL)
    …reporting, and when appropriate, recovery of money related to health care fraud , waste, and abuse. Duties include performing accurate and reliable medical review ... Counsel, and Medical Officers in order to achieve and maintain appropriate anti- fraud oversight. **Job Duties** + Responsible for developing leads presented to the… more
    Molina Healthcare (09/22/25)
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  • Data Analyst II Medical Economics

    Centene Corporation (Tallahassee, FL)
    …outcomes. + Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data. + Support execution of large-scale ... economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field or equivalent experience.… more
    Centene Corporation (09/30/25)
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  • Inpatient DRG Reviewer

    Zelis (FL)
    …negotiation with providers + Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs + Understanding of ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
    Zelis (09/27/25)
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  • Director Monitoring and Auditing

    AdventHealth (Orlando, FL)
    …learn new information systems and software programs + Working knowledge of Medicare and Medicaid billing issues + Demonstrated expertise with Microsoft Office ... Internal Auditor **Licensure, Certification, or Registration Preferred** : + Certified in Healthcare Compliance + Certified in Healthcare Privacy Compliance +… more
    AdventHealth (10/07/25)
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  • Analyst, Coding Data Quality Auditor

    CVS Health (FL)
    …CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... medical codes for diagnoses as documented for physicians and other qualified healthcare providers in the office and/or facility setting. + Thorough knowledge of… more
    CVS Health (10/02/25)
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  • Director of Quality and Compliance

    Trinity Health (Pensacola, FL)
    …Directors. + Ensure compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud , waste and abuse Compliance Program. Assure annual ... team members. **Minimum Qualifications:** + Must possess a comprehensive knowledge of healthcare delivery and management at a level as normally obtained through a… more
    Trinity Health (10/04/25)
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