- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …as assigned by management Qualifications: + Minimum of 5 years of FWA, healthcare and/or Medicare Advantage experience + Strong knowledge of Medicare ... Position Purpose: The Analyst - Fraud , Waste & Abuse (FWA) provides leadership in...a complex, high-pressure environment + Bachelor's degree in Business, Healthcare Administration or related field + High-degree of computer… more
- Molina Healthcare (Tampa, FL)
- …insurance company + Minimum of two (2) years' experience working on healthcare fraud related investigations/reviews + Proven investigatory skill; ability to ... data, medical records, and billing data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure… more
- Molina Healthcare (FL)
- …The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School… more
- 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
- 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
- CVS Health (Tallahassee, 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
- Humana (Tallahassee, FL)
- …identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional ... an impact** **Required Qualifications** + Bachelor's degree in Business, Finance, Healthcare Administration, Data Analytics, or a related field, or equivalent work… more