- CVS Health (Tallahassee, FL)
- …DME, and helps to ensure timely physician follow-up + Understands Payer /Plan benefits, policies, procedures, and can articulate them effectively to providers, ... members, and other key personnel Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments… more
- University of Florida (Gainesville, FL)
- …including but not limited to professional associations, federal and private payer guidelines, and coding networks. Meets with Department Chair or Administrator ... on a regular basis to review individual or product line coding issues. Verifies patient demographic and health insurance data for accuracy and resolves any discrepancies. Responsible for ensuring that there are no unsigned or missing operative records. Enters… more
- Centene Corporation (Tallahassee, FL)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides and/or facilitates education to members and their ... families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits + Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in… more
- AdventHealth (Orange City, FL)
- …to third party payers. + Monitoring receipt and distribution of third-party payer requests and logs. + Assists with locating appropriate facilities for placement ... of patients moving to another level of care. + Facilitation of the transfer to alternate care facilities including transport arrangements. + Facilitating referrals for home care services **The expertise and experiences you'll need to succeed:** **Minimum… more
- Select Medical (Brandon, FL)
- …business development team + Collect co-pays from patients, manage payer approvals, and conduct insurance authorizations and verifications **Qualifications** ... **Minimum:** + High School Diploma or GED + 1 Year Front Desk experience **Preferred:** + Healthcare experience **Additional Data** _Equal Opportunity Employer/including Disabled/Veterans_ Apply for this job… more
- Evolent (Tallahassee, FL)
- …initiatives, strategies, and developing/managing performance scorecards and action plans ( payer , provider, initiative, etc.). + Ability to travel as needed ... (up to ~40%) **.** **To comply with HIPAA security standards (45 CFR sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant… more
- Humana (Tallahassee, FL)
- …+ Experience with capitation rate development from either the state agency or payer perspective + Detailed understanding of healthcare claims Travel: While this is a ... remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week)… more
- AdventHealth (Maitland, FL)
- …performing functions related to the collections, payment and customer service for all payer and patient accounts. Manager monitors and directs the process of follow ... up with insurance in a timely accurate manner. Provides leadership with daily updates on volumes, dollars, and related systemic issues. Reviews daily assigned electronic claims and submission reports. Maintains a strong working relationship with HIM, Coding,… more
- Intermountain Health (Tallahassee, FL)
- …compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding review, audit findings, ... and appeal strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex internal and external… more
- Devereux Advanced Behavioral Health (Orlando, FL)
- …+ Knowledge of Florida Medicaid, Florida Managed Care Plans, and third-party payer systems + Familiarity with regulatory and compliance requirements + Understanding ... of Local and Federal billing requirements per Medicaid, CMS, etc. **Other:** + Valid driver's license _required_ + Successfully pass pre-employment medical screenings which include: Drug Screen. **Posted Date** _3 days ago_ _(8/26/2025 11:38 AM)_… more