- Prime Therapeutics (Tallahassee, FL)
- …we make. **Job Posting Title** Medication Therapy Management Technician - Remote **Job Description** Evaluates and authorizes approval of prior authorization ... formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.). + Proficiency in Pharmacy… more
- Humana (Tallahassee, FL)
- …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, and ... teams or organizational committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings… more
- Sedgwick (Tallahassee, FL)
- …Services & Insurance Sr. Claims Specialist | Medical Malpractice (PL) | Remote , Florida **PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical ... client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management.… more
- SitusAMC (Tallahassee, FL)
- …scaling of APIs in the cloud. + **Programming & Automation:** 6+ years coding in Python, Shell, or equivalent scripting languages for automation. + **AWS Cloud ... domain-specific data + Understands Agentic RAG (Retrieval-Augmented Generation) architectures \#LI-AS1 #LI- Remote Note: This job description is not intended to be… more
- National Health Transport (Miami, FL)
- …duties as assigned. Required Qualifications: + High School Graduate/GED + Medical coding training and experience + Familiar with Medicare/Medicaid laws and billing + ... but would generally be 8:00am-4:30pm, Monday through Friday. This position is not remote . Note: This description indicates, in general terms, the type and level of… more
- Sedgwick (Tallahassee, FL)
- …Services & Insurance Claims Advisor, Environmental | Professional Liability | REMOTE **Job Description Summary** To analyze complex or technically difficult ... client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management.… more
- CVS Health (Tallahassee, FL)
- …in analyzing monthly billing variances (20%) + Load new rates and specific coding relevant to the group plan and products sold. This set up information ... is critical for the import process from billing to accounts receivable/payable to ensure accurate and efficient revenue reporting and vendor payments (10%) + Process administrative claims to collect payment for monthly administrative invoices (5%) - Complete… more
- Molina Healthcare (Jacksonville, FL)
- …risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of medical economics and financial reporting. Must be able to ... walk stakeholders (internal and external) through basic financial reconciliations. + Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and… more
- Molina Healthcare (Tampa, FL)
- …standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts ... and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. * Understanding of… more
- The Hartford (Hollywood, FL)
- …solutions. + Conduct code reviews and ensure adherence to best practices and coding standards. + Troubleshoot and resolve technical issues related to AWS services. + ... Implement security best practices to protect sensitive data. + Stay updated with the latest AWS technologies and industry trends. Qualifications: + Bachelor's degree in Computer Science, Information Technology, or a related field. + 8+ years of experience in… more