- Evolent (Tallahassee, FL)
- …or required. **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity ... rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Tallahassee, FL)
- …or required. **What You Will Be Doing:** . Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially meet the applicable medical ... rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Intermountain Health (Tallahassee, FL)
- …Billing, Follow-Up, Collections) required + Knowledge of Medicaid and Medicare billing regulations required **Physical Requirements** + Operate computers and ... other office equipment requiring the ability to move fingers and hands. + Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment. + May require lifting and transporting objects and office supplies,… more
- Molina Healthcare (FL)
- …Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. **JOB QUALIFICATIONS** **Required Education** HS Diploma ... or GED **Required Experience** 1-3 years' experience in an administrative support. **Preferred Education** Associate degree **Preferred Experience** 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested… more
- Elevance Health (Tampa, FL)
- … of complex exception requests and CMS change requests. + Perform supervisory review of workload involving complex areas of Medicare part A reimbursement ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...experienced associates as assigned. + Prepare and perform supervisory review of cost report desk reviews and audits. +… 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
- Humana (Tallahassee, FL)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a… more
- Humana (Tallahassee, FL)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- BAYADA Home Health Care (Jacksonville, FL)
- …experienced and compassionate **Director** to manage operations at our **Jacksonville, FL Medicare -certified Home Health office** . The ideal candidate will have a ... strong background in healthcare administration, regulatory compliance ( Medicare Conditions of Participation), clinical coordination, and business operations. This… more