- Highmark Health (Tallahassee, FL)
- …Business Solutions leadership in strategic activities to expand IT capabilities for Medicaid growth in the dental market by: Applying SME knowledge to analytical ... strategic thinking to identify business needs for growing and sustaining the Medicaid business. Apply SME knowledge and oversee multiple teams' activities related to… more
- Molina Healthcare (Orlando, FL)
- **Job Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Humana (Tallahassee, FL)
- …of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid , and other health plans to millions. By integrating insurance with care ... role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's...experience to join this team. As an Insurance Strategy Lead , you will directly contribute to high-impact strategy projects,… more
- ChenMed (Miami, FL)
- …resolve credentialing related questions and issues from markets. + Identifies process improvement opportunities and presents recommendations to Credentialing ... in this role is also responsible for assessing and providing continuous improvement recommendations to the provider enrollment process , co-facilitating … more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** As a Lead AI/ML DevOps Engineer at Humana, you will be responsible for leading the development, ... of AI/ML solutions. Additionally, you will focus on streamlining the deployment process , ensuring the scalability and reliability of AI/ML models, and monitoring… more
- HCA Healthcare (Fort Pierce, FL)
- …to join an organization that invests in you as a Facility Outpatient Coder Team Lead ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... are looking for a dedicated Facility Outpatient Coder Team Lead like you to be a part of our...+ Ensures rebill requests are entered timely through the system/ process outlined in company/HSC policy + Answers coding related… more
- Humana (Tallahassee, FL)
- …Operations, you will shape strategic direction, influence senior stakeholders, and lead a high-performing team of marketers. You'll drive collaborative go-to-market ... teams and external vendors, and ensure compliance with CMS, Medicaid , and Pharmacy marketing regulations. **Key Responsibilities** **Campaign Strategy, Execution… more
- Centene Corporation (Tallahassee, FL)
- …+ Provide claims operations expertise for RFPs, RFIs, and audit readiness. + Lead process improvement initiatives in collaboration with cross-functional ... matter expert (SME) for claims operations, change control, and business implementations. + Lead Claims Process Change Control, including approval of process … more
- Highmark Health (Tallahassee, FL)
- …the key BU's for the Organization's value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across ... providers enrolled in the Organization's value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a… more
- Molina Healthcare (St. Petersburg, FL)
- …in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
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