- Molina Healthcare (FL)
- …administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care ... of deliverables/submission between staff and governmental agencies and contract review . * Maintains calendar and databases documenting regulatory filings, approvals… more
- Prime Therapeutics (Tallahassee, FL)
- …help ensure efficient and effective solutions are implemented + Perform and review detail plans to address complex compliance issues by identifying goals, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- CenterWell (Jacksonville, FL)
- …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally… more
- Datavant (Tallahassee, FL)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Actalent (Sunrise, FL)
- …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... standardized Review Criteria. + Coordinate with the Medical Director/Physicians for...Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical… more
- University of Miami (Medley, FL)
- … Medicare Severity Diagnostic Related Groups (MS-DRG) assignment. + Review medical record documentation for major complications and comorbidities (MCC), ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization ... in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially... & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in "Buy and Bill"… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** **This position is responsible for physician contract review and interpretation; as well as, the building and maintenance of rates ... necessary research to obtain and maintain non-contracted payer reimbursement including Medicare , Medicaid, Tricare and other gov't payers. * Responsible for ensuring… more
- Cardinal Health (Tallahassee, FL)
- …about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while ... High School diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Cardinal Health (Tallahassee, FL)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more