- Intermountain Health (Tallahassee, FL)
- …equivalent (GED) required + One (1) years of experience in hospital or physician back-end revenue cycle (Payment Posting, Billing, Follow-Up) required + Knowledge of ... Medicaid and Medicare billing regulations required + Two (2) years of...+ Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
- Amgen (Orlando, FL)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms. + Review patient-specific information in cases where the site has...the products are covered under the benefit design (Commercial, Medicare , Medicaid). + Serve as a payer expert for… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Instructs patients to complete any questionnaires that might be required by physician . + Schedules follow-up, cancels, and edits appointments, and records no-show… more
- Evolent (Tallahassee, FL)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization … more
- Humana (Miramar, FL)
- …in the Health Plan contractual agreements. The Pre-Service Coordinator will review inbound referrals and correspondence for processing, fulfilment or resolution ... utilizing all appropriate software systems and resources. Screen physician 's orders and documentation to identify that all qualifying medical documentation and… more
- CenterWell (Delray Beach, FL)
- …with the care team through daily huddles. + Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of cooperation in practice by ... defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . APP, ... advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of this position include , but… more
- Molina Healthcare (Miami, FL)
- …appeals and supporting market performance. Performance activities include physician auditing, training, and performance improvement activities. Additionally, they ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more