- Elevance Health (Tampa, FL)
- ** Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be considered. This position will work a hybrid model ... Document Improvement Director** is responsible for leading encounter processing, diagnostic documentation and claims integrity across CareBridge. The ideal… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …The Clinical Reviewer serves as a subject matter expert in the clinical review of claims , claim disputes, appeals and FWA special investigations ... findings and recommendations + Comply with the CMS Program Integrity Manual and Statement of Work guidelines + Maintains...Qualifications: + Minimum 5-7 years of experience as a clinical reviewer of facility claims in a… more
- Banner Health (FL)
- …patient care. POSITION SUMMARY This position is responsible for the interpretation of clinical documentation completed by the health care team for the health ... record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with...findings. 4. Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity… more
- MyFlorida (Bunnell, FL)
- …involve processing Medicaid HMO's, Medicare and third party/commercial insurance claims . Responsible for reviewing insurance web portals for eligibility, ... Policy timelines. Responsible for collaborating with other departments, if necessary. Reviews clinical EHR for snomed HMC and ICD-10 codes for accuracy. Develop… more
- AdventHealth (Altamonte Springs, FL)
- …integrity , and ability to function as a liaison to the Quality and Clinical Documentation Improvement teams for the Multi-State Division. Assigns codes to ... Coding programs. Will work with Case Management, the Billing Office, Coding Manager, Clinical Documentation Improvement specialists and the coding team to code… more
- Healthfirst (FL)
- + Prepare cases for the clinical team by gathering documentation , loading evidence, and making calls to members and providers. + Perform administrative ... + Interacts with other departments including Contact Center Operations, Claims , DSE, and E&B to resolve member and provider...denial files from delegated vendors and prepares cases for Clinical Specialist reviews. + Maintains file integrity … more
- Intermountain Health (Tallahassee, FL)
- …RCO Appeals Specialist is responsible for researching and appealing denied medical claims . Responsible to proactively identify insurance denial trends and to then ... self-funded, State and Federal insurance) to appropriately appeal medical claims that have been denied. + Conducts and refers...true reason of the denial and review payer contracts, clinical data and other data to be able to… more
- AdventHealth (Altamonte Springs, FL)
- …Coding programs. Will work with Case Management, the Billing Office, Coding Manager, Clinical Documentation Improvement specialists and the coding team to code ... turn-around time of 3 days or less.l. Works closely with the CDIS ( Clinical Documentation Improvement Specialists) for clear, complete documentation .m.… more
- ZOLL Medical Corporation (Gainesville, FL)
- …to promote consistent use (Local Medical Education Programs, Tradeshows, clinical symposiums and conferences). Call points include: Physicians (Cardiologists, ... essential ordering and billing requirements.Essential Functions + Provide customers with relevant clinical data that supports the risk of Sudden Cardiac Death in… more
- AdventHealth (Altamonte Springs, FL)
- …Employee Clinic Manager, regional Employee Health Managers, Medical Directors, and both clinical and non- clinical staff across various healthcare facilities to ... The Employee Health Registered Nurse also oversees Workers' Compensation claims , hospital surveillance programs, and regulatory compliance related to occupational… more