- MyFlorida (Tallahassee, FL)
- …design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data ... include, but not be limited to, the following: * Identify suspicious patterns in claims data and other sources by applying your knowledge of heath care coding… more
- Molina Healthcare (St. Petersburg, FL)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... Mastery * Track record coordinating cross-functional action plans with Enrollment, Claims , Pharmacy, Network, and Member Services * Hands-on experience maintaining… more
- Jabil (St. Petersburg, FL)
- …outside counsel. The Global Litigation team handles all of Jabil's litigation and claims matters spanning a number of subject areas including antitrust, breach of ... managing commercial and labor & employment litigation, pre-litigation disputes, and claims . + Efficiently and proactively managing matters and development of case… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of ... integrity of enterprise revenue, and enabling the organization's overall risk adjustment strategy. Knowledge/Skills/Abilities + Responsible for encounters accuracy &… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …This role will also encompass document management, learning and development, risk management, data integrity and process excellence. The ideal candidate will ... to monitor Quality performance and drive data-driven decision-making. Maintain risk management toolkit and best practices. + **Process Improvements:** Identify… more
- Molina Healthcare (FL)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Elevance Health (Tampa, FL)
- …II** is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Molina Healthcare (FL)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …JNT517, Uli - may require non-traditional distribution requirements). + ** Risk Mitigation & Prioritization:** Lead structured prioritization efforts across the ... strategic adjustments that maintain patient access and minimize revenue risk . + **People Development & Future Planning:** Build team...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …technology transfers to CDMOs, including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of upstream manufacturing ... and improvements post-approval. + Author and/or review technical reports, protocols, risk assessments, and relevant sections of regulatory submissions (IND, BLA,… more