- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...review . + Knowledge of OASIS, Home Care and Medicare regulations + Excellent organizational, interpersonal and communication skills… more
- Humana (Tallahassee, FL)
- …help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or… more
- Humana (Tallahassee, FL)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- AdventHealth (Altamonte Springs, FL)
- …positions taken on the hospital cost report, or other required reporting + Review the Medicare and Medicaid Uniform Contractual Worksheet-Third Party Settlement ... activities. These activities include preparation and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and… more
- CVS Health (Tallahassee, FL)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...in internal monitoring audits and coaching feedback sessions to review schedule adherence, quality, selling skills and compliance. +… more
- Sedgwick (Tallahassee, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, ... specialized document review , and analysis and interpretation of interventions for the...analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We… more
- Humana (Deland, FL)
- …caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ... through service, organizations, activities and volunteerism + Experience selling Medicare products + Bilingual with the ability to speak,...and therefore subject to driver license validation and MVR review . + Any Humana associate who speaks with a… more
- Molina Healthcare (Miami, FL)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Humana (Tallahassee, FL)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Tallahassee, FL)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more