- Healthfirst (FL)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently:** + ... within a framework that measures productivity and quality for each Specialist against expectations** + **Work independently exercising judgment starting the case… more
- Molina Healthcare (Tampa, FL)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- AssistRx (Orlando, FL)
- …that they need. A Day in the Life as a Bilingual Patient Access Specialist : This role works directly with healthcare providers & insurance plans/payers to gather ... provided for a specific pharmaceutical product. The Bilingual Patient Access Specialist will support the healthcare providers addressing questions regarding coding… more
- BayCare Health System (Clearwater, FL)
- …information, documentation, and medical records. Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all ... management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. + Participate in… more
- AssistRx (Maitland, FL)
- …coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
- AssistRx (Maitland, FL)
- …provided for a specific pharmaceutical product. The Insurance Verification Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
- HCA Healthcare (Ocala, FL)
- …Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is valued? If you are… more
- MyFlorida (Tallahassee, FL)
- PARALEGAL SPECIALIST - 37001079 Date: Dec 16, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 866476 Agency: Environmental Protection Working Title: PARALEGAL SPECIALIST - 37001079 Pay Plan: Career Service Position Number: 37001079 Salary:… more
- Cardinal Health (Tallahassee, FL)
- …performance and client satisfaction. + Resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Verifies ... insurances including all Medicaid states on paper and online. + Oversees appeals and denials management to maximize revenue recovery and minimize financial leakage,… more
- CVS Health (Tallahassee, FL)
- …Responsibilities** - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more