- CVS Health (Tallahassee, FL)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... activities, tracking completion of action items, resolving issues, and mitigating risk . * Champion a culture of continuous improvement, curiosity, collaboration, and… more
- Banner Health (FL)
- …coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple ... of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and...and must be familiar with coding and abstracting software, claims processing tools, as well as common office software… more
- Evolent (Tallahassee, FL)
- …found by testing teams during test execution + Consult with the manage and report risk , issues, and decisions with the lead / manager + Responsible to attend and if ... - Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in… more
- Robert Half Legal (Orlando, FL)
- …matters. * Manage and resolve disputes related to litigation, liens, and bond claims . * Review and ensure adherence to Federal Acquisition Regulation clauses. * ... Support field operations by addressing legal concerns and implementing risk mitigation strategies. * Draft, negotiate, and review various commercial contracts to… more
- Defense Contract Management Agency (Perry, FL)
- …provisions of contracts by designing, implementing, and maintaining a risk -based surveillance program and assessment plan. Identifies opportunities for process ... at the time of application) to support your educational claims . Or, if you are using education to qualify...at the time of application) to support your educational claims . The transcripts must include your name, the name… more
- Marriott (Longboat Key, FL)
- …otherwise negotiating with others. * Implements action plans to monitor and control risk . * Reports any procedure violations to the Director of Loss Prevention and ... and statistical data. * Assists in the management of claims by ensuring proper procedures are followed and documented....Report all employee accidents and guest liability incidents to Claims Reporting Service in a timely manner. * Administer… more
- AdventHealth (Altamonte Springs, FL)
- …gaps in lowering the cost of care. The Analyst uses healthcare data ( claims , labs, EHR data) analytics to gain insights into provider ordering, member adherence, ... insurance accounting methods and reporting, standards development, utilization measurements, risk segmentation, and financial modeling + Ability to conduct oneself… more
- Healthfirst (FL)
- …and CMS guidelines and to ensure member satisfaction + Lead cross functional risk assessment root cause analysis activities to identify, assess and address key risks ... institution + Leadership experience in a high-volume production billing, enrollment, claims , call center environment or related environment. + Basic understanding of… more
- Centene Corporation (Tallahassee, FL)
- …pricing, contract/network analysis, and/or ROI evaluation preferred. Familiarity with claims payment, utilization management, provider/vendor contracts, risk ... adjustment for government sponsored healthcare desired. Pay Range: $105,600.00 - $195,400.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time… more
- Molina Healthcare (St. Petersburg, FL)
- …responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of ... and benefit realization + Demonstrates deep understanding of Core Operations, Claims and Enrollment processes, deliverables, vendor partners and technology platforms… more