- Ankura (FL)
- …+ You'll work with critical data: Dive deep into patient volumes, payer contracts, financial performance, and utilization metrics to build a complete picture ... and utilization trends for all service lines, facilities, and payer contracts. + Healthcare Metrics Analysis: Analyze healthcare-specific operational metrics… more
- CenterWell (Tallahassee, FL)
- …identify educational opportunities. + Conduct research as needed. + Participate in Payer calls/chart reviews. + May participate in provider education programs on ... guidelines, healthcare regulations (including HIPAA, state and federal compliance), and payer requirements + Proficiency in Microsoft Office Suite (Word, Excel,… more
- MyFlorida (Largo, FL)
- …Medicare A&B, Medicaid, Medicaid Managed Care, Third Party Insurers, and any other payer for the State Veterans' Homes. + Review and monitor resident accounts ... ensuring that the account set up and payer types have been correctly established by the facility. + Verify insurance eligibility. + Review and monitor accounts on a… more
- Sumitomo Pharma (Tallahassee, FL)
- …goal of supporting attainment of coverage goals and maximizing net revenue + Develop payer & provider deal models to assess the implications of deal scenarios on ... and developing new approaches, processes and methodologies + Experience evaluating PBM/ payer contracts to ensure they support Market Access objectives +… more
- University of Miami (Miami, FL)
- …division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines. + Assists leadership with the ... pathology, laboratory, and state/ federal regulations. Oversees the Medicare Secondary Payer Questionnaire (MSPQ) process in accordance with Centers for Medicare &… more
- Wolters Kluwer (Tampa, FL)
- …prior authorization logic. You will collaborate with product, engineering, and payer stakeholders to deliver standards-compliant solutions that optimize clinical and ... & Compliance: Familiarity with HL7 FHIR, interoperability frameworks, and payer -provider data exchange requirements. + Leadership & Communication: Strong ability… more
- Cognizant (Tallahassee, FL)
- …with 20 to 24 years of expertise in Program Management, particularly in Healthcare Payer industry. The ideal candidate will manage and deliver complex projects in a ... impact on society. **Required Skills and Qualifications:** . US Healthcare Payer Delivery experience and domain expertise (20+ years). . Significant experience… more
- University of Miami (Miami, FL)
- …resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines. Oversees and clears patient work ... pathology, laboratory, and state/ federal regulations. + Completes the Medicare Secondary Payer Questionnaire (MSPQ) at time of scheduling prior to services being… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …RWE, and other evidence generation initiatives to support regulatory, HTA, and payer submissions, and demonstrate the differentiated value of our products + Utilize ... associations etc. + Deep understanding of global HTA and payer requirements, regulatory frameworks, and healthcare systems. + Deep understanding… more
- Globus Medical, Inc. (FL)
- …open billings in a timely manner + Identifies and reports to management any payer issues with regards to billing and collections + Reviews, analyzes, and reconciles ... various priorities in a fast-paced environment + Working knowledge of payer reimbursement guidelines and government, regulatory and company billing and compliance… more