- CenterWell (Tallahassee, FL)
- …billing operations with a focus on contract interpretation, validation, and payer setup. This role works collaboratively with internal departments, professional ... additional duties as assigned to meet departmental needs. **Key Responsibilities:** + ** Payer Setup:** Create and manage payer configurations, ensuring accuracy… more
- University of Miami (Miami, FL)
- …+ Follows the authorization process using established criteria as set forth by the payer or clinical guidelines + Accurate review of coverage benefits and payer ... the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options + Ensures… more
- Cardinal Health (Tallahassee, FL)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... the product must be fully exhausted. + Track any payer /plan issues and report any changes, updates, or trends...As needed conduct research associated with issues regarding the payer , physician's office, and pharmacy to resolve issues swiftly… more
- Intermountain Health (Tallahassee, FL)
- …customer service. **Essential Functions** + Evaluate payment variances in Epic WQs against payer contracts to determine if payer underpaid or overpaid, and ... analysis and leverages data to resolve errors in Epic proration rules, payer under and/or overpayment trends, opportunities in billing, and opportunities with… more
- MyFlorida (Fort Pierce, FL)
- …to determine delivery of services. Ensures that any applicable hierarchy of payer sources is used appropriately. Screens for Medicaid eligibility, PAC Waiver ... Ensures Ryan White services are consistently used as the payer of last resort. Updates all required information regarding... of last resort. Updates all required information regarding payer source eligibility on his/her clients in the CAREWare… more
- Humana (Tallahassee, FL)
- …targeted action plans. + Customize strategies to align clinical programs with payer -specific needs (MA, D-SNP). + Provide clinical input into network development, ... + years in managed care industry, either provider or payer . + Thorough knowledge of health care utilization and...geographic boundaries **Preferred:** + Experience in both provider and payer roles + Prior executive level role with successful… more
- Cardinal Health (Tallahassee, FL)
- …collections + Ensure all oncology-related claims are submitted accurately and within payer timelines to prevent denials and delays + Support change management with ... implement strategies to safeguard reimbursement, including proactive AR management and payer follow-up + Collaborate with operations, clinical, and financial teams… more
- Cardinal Health (Tallahassee, FL)
- …to optimize cash flow, reduce aging accounts, and ensure compliance with payer and regulatory requirements. **Responsibilities:** + Lead and manage the daily ... of escalation for complex or high-dollar claims. + Stay current with payer policy changes, compliance regulations, and industry best practices. + Analyze trends… more
- Community Health Systems (Naples, FL)
- …Submits and processes claims accurately and efficiently, ensuring compliance with payer requirements and company policies. + Communicates with insurance companies, ... corrective actions. + Reviews and corrects claim filing edits based on payer requirements and electronic health record (EHR) system alerts. + Maintains accurate… more
- Cardinal Health (Tallahassee, FL)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... a timely manner + Mediate effective resolution for complex payer /pharmacy issues toward a positive outcome to de-escalate +...appropriate sections of the database + Must track any payer /plan issues and report any changes, updates, or trends… more