- HCA Healthcare (Ocala, FL)
- …is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as ... receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical/ billing , medical payment posting, and/or cash application. + Prior… 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. ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… 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
- Cognizant (Tallahassee, FL)
- …Director based on the review of clinical documentation in accordance with Medicare , Medicaid , and third-party guidelines. . Effectively document and log ... to referral, preauthorization, medical necessity, non-covered services, investigational/experimental and billing resulting in denials and/or delays in payment. .… more
- University of Miami (Miami, FL)
- …of scheduling prior to services being rendered and in accordance with Centers for Medicare & Medicaid Services (CMS) Federal regulations, as needed. + Reviews ... and clears patient work queues daily to ensure data integrity, prompt billing and minimal AR days. + Identifies and collects patient's self-pay responsibility… more
- CVS Health (Tallahassee, FL)
- …operations. + 3+ years of experience in healthcare. + Working knowledge of Medicare , Medicaid and Third-Party Insurance payers and reimbursement guidelines. + ... of Home Infusion, DME ( _Durable Medical Equipment_ ) and/or Specialty Pharmacy billing . + Excellent customer service skills. + Experience with medical billing … more
- J&J Family of Companies (Jacksonville, FL)
- …pre-authorization, billing , coding, claims, and appeals/grievances); REMs certification; Medicare and Medicaid rules and regulations; and state-specific ... product administration and monitoring. + Educate staff on payer requirements, coding, billing , claim submission, and acquisition. + Share TC insights with coalition… more
- Centene Corporation (Tallahassee, FL)
- …a healthcare organization, and medical claims. Knowledge of health care, managed care, Medicare or Medicaid .Pay Range: $22.79 - $38.84 per hour Centene offers ... policies and standards **Education/Experience:** Associate's degree and claims processing, billing and/or coding experience preferred. Three years of experience in… more
- Highmark Health (Tallahassee, FL)
- …duties as specified. + Identify and report improper coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in ... formulary terminology + Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They… more
- Molina Healthcare (FL)
- …observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. ... standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/ billing (UB04/1500 form). * Advanced understanding of key managed care concepts… more