- CVS Health (Tallahassee, FL)
- …each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist , you will work with internal teams to provide cutting-edge solutions that will directly improve ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...clinical, and other data insights that directly improve the quality and efficiency of patient care. At LogixHealth, we're… more
- CVS Health (Tallahassee, FL)
- …and financial accuracy. **Required Qualifications** + 1-2+ years of experience in a quality audit or claims testing environment. + Working knowledge ... day. **Position Summary** The Senior Claim Benefit Specialist serves as a quality champion and...process improvements. + Participate in special projects and targeted quality audit initiatives. + Provide subject matter… more
- Sedgwick (Miami, FL)
- …providers to discuss employee's clinical status, progress and work status. + Achieves appropriate quality audit scores on a consistent basis. + Acts as clinical ... Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : To perform clinical evaluations, consult providers and… more
- MyFlorida (Tallahassee, FL)
- RETIREMENT SPECIALIST III - 72002660 Date: Oct 7, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 862670 Agency: Management Services Working Title: RETIREMENT SPECIALIST III - 72002660 Pay Plan: Career Service Position Number: 72002660… 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 ... to work and receive care. In this **Inpatient Facility/HIMS Certified Medical Coder, Quality Associate** position, you bring your **5 years of acute care inpatient… more
- Elevance Health (Tampa, FL)
- …letters. + Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation ... responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of...purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside… more
- AdventHealth (Altamonte Springs, FL)
- …Coding Clinic, CMS guidelines, NCCI guidance, etc. + Provides outcomes of coding quality audit reviews with leadership + Maintains current knowledge of coding ... necessary to ensure documentation supports the coding of the claim . Additionally, this role equips staff with the knowledge... quality improvements. + Provides input on which quality audit and metrics will be tracked… more
- Elevance Health (Tampa, FL)
- …and reference information to generate audit determinations and formulate detailed audit findings letters. + Maintains accuracy and quality standards as ... clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise,...Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation… more
- AdventHealth (Maitland, FL)
- …+ Reviews and responds to third-party and regulatory agency requests, including quality studies and audit findings. Qualifications **The expertise and ... under OPPS. The APC Coordinator may assist with monthly quality reviews, RAC, and post-payment audits. Will routinely monitor...not final billed and ensure we are billing clean claims . The APC Coordinator will assist in overseeing the… more