- Humana (Tallahassee, FL)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional… more
- Humana (Tallahassee, FL)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- Intermountain Health (Tallahassee, FL)
- **Job Description:** Provides assistance to the Reimbursement Manager to control or review the following areas for government and third party payers for assigned ... appropriately recorded, reviewed, and reconciled. Reviews or prepares monthly Medicare and Medicaid contractual allowance calculations using technically acceptable… more
- Molina Healthcare (Miami, FL)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... with a consistent focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject matter expert to colleagues… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- University of Miami (Coral Gables, FL)
- …1 ( Medicare Billing Coding & Financial) works independently to review internally and externally sponsored clinical research, including agreements and proposals, ... 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 Office of… more
- Prime Therapeutics (Tallahassee, FL)
- …qualified entities across all lines of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs, including but ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...$17.85 - $25.48 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- CenterWell (Deerfield Beach, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five… more
- AdventHealth (Maitland, FL)
- …quantify, and present contract compliance violations. He/she will perform extensive review of contract language, state and federal regulations, and payor practices ... This person demonstrates attention to detail and competencies in contract language review , research, decision support, and financial analysis in the preparation and… more
- Elevance Health (Tampa, FL)
- …end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare / Medicaid regulatory policies regarding FFS and zero-dollar claims. **How you ... associated reporting and KPIs. + Oversees design and execution of provider/chart review workflows to ensure high quality encounter submissions. + Liaises with senior… more