- Centene Corporation (West Palm Beach, FL)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides education to members and their families on ... procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs + Provides feedback to leadership on opportunities to improve and enhance care and quality… more
- Caris Life Sciences (Tallahassee, FL)
- …+ Utilize market oncology understanding and experience while discussing the healthcare payer environment and its impact on physicians and ancillary providers. + ... Billing/Reimbursement support as it relates to patients, practices and hospital customers. + Understand information technology and how it interfaces with physician office systems. Able to demo different technology solutions, ie Portal, EMR connectivity and… more
- Cognizant (Tampa, FL)
- …House:** TriZetto offers product solutions to the healthcare industry from streamlining payer processes to automating insurance operations. The practice has its own ... ecosystem of businesses including positions in marketing, project management, and technical roles - such as developers and analysts. **Products include:** + Clinical CareAdvance and CareAdvance Provider + EngageMember + EngageProvider + Facets + NetWorX… more
- Evolent (Tallahassee, FL)
- …years of professional experience in claims-based healthcare analytics with a payer , provider, clinical vendor, managed care, or related healthcare consulting entity ... is preferred + Experience using data visualization software (s) to package analytical insights (Power BI, Tableau, or similar) is preferred + Familiarity with healthcare reimbursement methodologies and calculations such as DRGs, Revenue Codes, CPT Codes, RVUs,… more
- HCA Healthcare (Orange Park, FL)
- …transition of care issues. + You will make appropriate referrals to third-party payer , disease and case management programs for recurring patients and patients with ... chronic disease states. + You will act as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies. You will serve as an advocate for patient's rights, needs and values.… more
- HCA Healthcare (Panama City, FL)
- …initial screening of identified patients for appropriate level of care, priority, payer status and high risk criteria. + Collaborates with physicians and Health ... care team in planning the care of patients and families within the acute setting and along the healthcare continuum. + Reviews patient population for appropriate disposition and communicates with ED/primary physician. + Involves the physician, patient and… more
- HCA Healthcare (Gainesville, FL)
- …as an educational resource to patients, families, interdisciplinary team members, payer representatives, and other parties as appropriate about behavioral services. ... + Reviews, coaches, and helps with the training of new staff/interns as assigned within approved practice and program guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with… more
- HCA Healthcare (Ocala, FL)
- …thorough working knowledge of the rules of Medicare, Medicaid, and private payer regulations and processes. You will possess a thorough understanding of managed-care ... concepts and length-of-stay management relating to patient and organizational fiscal responsibility. + You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or psychosocial needs. + You… more
- HCA Healthcare (Orange Park, FL)
- …an educational resource to patients, families, interdisciplinary team members, payer representatives, and other parties as appropriate regarding behavioral services ... . Performs utilization review as assigned . Participates in developing department goals/objectives and clinical programming . Reviews, coaches and assists with training of new staff/interns as assigned within approved practice and program guidelines. .… more
- University of Miami (Coral Gables, FL)
- …Verifies insurance information with patients for scheduled appointments and contacts payer to verify eligibility and authorization requirements.2. Adds or updates ... financial status classifications in appropriate systems.3. Contacts caregivers and patients for HMO payers to obtain authorizations and referrals.4. Generates and links referrals to appropriate visit once authorization is obtained.5. Responds to customer… more