- MyFlorida (Miami, FL)
- …for state licensure and federal certification requirements for participation under Medicare / Medicaid . The incumbent will document findings and complete written ... and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities,… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of Network Adequacy requirements and process optimization, primarily focusing on the Medicaid line of business, with a deep understanding of network build… more
- CVS Health (Tallahassee, FL)
- …clinical oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare - Medicaid Plan) * Develop and lead clinical strategy and ... * Actively participate in meetings and communication with the State Department of Medicaid in person as needed. * Outward facing position to interact and collaborate… more
- Cardinal Health (Doral, FL)
- …of insurance claim processing and denial management preferred. + Familiarity with Medicare , Medicaid , and managed care preferred. + Proficiency in billing ... and increase cash flow for the organization. This position is a Medicaid insurance associate on the revenue cycle management team. **Responsibilities:** + Review… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... environment + CNA or Medical Assistant experience + Quality experience + Medicare experience + Familiarity with medical terminology and/or ICD-10 codes **Additional… more
- Cognizant (Tallahassee, FL)
- …Director based on the review of clinical documentation in accordance with Medicare , Medicaid , and third-party guidelines. . Effectively document and log ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information**… more
- University of Miami (Miami, FL)
- … Secondary Payer Questionnaire (MSPQ) process in accordance with Centers for Medicare & Medicaid Services (CMS) Federal regulations.12. Reviews and processes ... information with discretion, maintaining confidentiality of all laboratory information according to laboratory policy.13. Supervises the daily activities of the Laboratory Accessioner personnel. Seeks feedback from the team and physicians in identifying… more