- Elevance Health (Tampa, FL)
- …based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective ... and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. +… more
- Healthfirst (FL)
- …policy disputes and appeals . + Reviews claims editing escalated provider disputes/ appeals and provides guidance on coding rules and industry standards across ... configuration to resolve the provider payment discrepancies. + Reviews medical records to ensure coding is consistent...discrepancies. + Reviews medical records to ensure coding is consistent with the services billed and compares… more
- Molina Healthcare (Miami, FL)
- …for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding certification. To all current Molina employees: If you are interested ... and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. +… more
- TEKsystems (Tampa, FL)
- …will be on the bill review team specifically working in the backlog of appeals . The Bill Review Analyst position holds accountability for accurate and timely ... review, processing and payment of bills to include pre- coding accuracy and adjudication of appeals /provider reconsideration...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more