• Value-Based Reimbursement Specialist

    Highmark Health (Tallahassee, FL)
    …share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing ... interpretation, and outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health… more
    Highmark Health (08/20/25)
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  • Specialist , Government Contracts - Remote…

    Molina Healthcare (FL)
    … Experience** * 2+ years compliance related experience. * 1+ years in Medicare . ** Preferred License, Certification, Association** N/A To all current Molina ... administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care… more
    Molina Healthcare (08/08/25)
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  • Patient Support Specialist

    Cardinal Health (Tallahassee, FL)
    …and appeals, preferred + Cell/Gene therapy and/or Oncology experience, preferred + Knowledge of Medicare , Medicaid and Commercially insured payer ... and efficiency for the program **_Qualifications_** + Previous customer service experience, preferred + High School diploma or equivalent, preferred +… more
    Cardinal Health (08/19/25)
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  • Revenue Integrity Coding Specialist - CPC…

    Trinity Health (Fort Lauderdale, FL)
    …educate on improved documentation to support coding. Neurosurgery experience is highly preferred . CPC license is REQUIRED. **What you will do:** Responsible for ... abstracts data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines. Ensure medical documentation and coding compliance with Federal,… more
    Trinity Health (08/14/25)
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  • Senior Specialist , Provider Network…

    Molina Healthcare (FL)
    …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... codes, etc. + Access and Excel - intermediate skill level (or higher) ** Preferred Education** Bachelor's Degree ** Preferred Experience** + 5+ years managed care… more
    Molina Healthcare (08/02/25)
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  • Sr Specialist , Credentialing, Network…

    Cardinal Health (Tallahassee, FL)
    …scheduled training. **_Qualifications_** + Bachelors degree or equivalent experience in Managed Care preferred + 2-4 years experience in health care preferred + ... Pharmacy Technician experience a plus, not required + Familiarity with Medicare and Medicaid + Proficient in Microsoft Office (Excel VLOOKUPS) + Strong written and… more
    Cardinal Health (07/24/25)
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  • Consumer Access Specialist Nights

    AdventHealth (Riverview, FL)
    …to limit use of unauthorized overtime. Performs eligibility check on all Medicare inpatients to determine HMO status and available days. Qualifications **The ... you'll need to succeed:** High School Grad or Equivalent 1 Work Experience Preferred This facility is an equal opportunity employer and complies with federal, state… more
    AdventHealth (08/22/25)
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  • Member Engagement Specialist

    Wider Circle (Palm Coast, FL)
    …phone or video conferencing. + A genuine interest in working with Medicare /DSNP/Medicaid populations and a commitment to building strong, supportive relationships. + ... hours) and reliable transportation when necessary. + 3-5 years relevant experience. Preferred Requirements + Associate or Bachelor Degree + 3+ years of relevant… more
    Wider Circle (07/31/25)
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  • Delaware Valley ACO Fellowship

    Humana (Tallahassee, FL)
    …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...Board + Leads strategic planning efforts to develop a specialist network within the ACO + Develops a health… more
    Humana (07/30/25)
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  • Referral Coordinator

    ChenMed (Largo, FL)
    …5 days. + Orders have been approved (when needed). + Schedules patient ( Preferred Providers List of Specialist ) and notifies them of appointment information, ... with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred + Healthcare experience within the Medicare Advantage population… more
    ChenMed (07/01/25)
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