- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist II is responsible for follow-up of all appeals submitted. This individual manages denial/appeal correspondence and ... Quality work is imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems, you'll play a vital role in supporting… more
- Molina Healthcare (Miami, FL)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- BayCare Health System (Clearwater, FL)
- …and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies, ... and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure accurate and… more
- AdventHealth (Altamonte Springs, FL)
- …and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all rules and ... department staff to obtain further patient information to be used in the appeals process if necessary. . Provide reports, education, and training on identified… more
- AssistRx (Orlando, FL)
- …a $750 referral bonus! A Day in the Life as a Benefits Verification Specialist : This role works directly with healthcare providers & insurance plans/payers to gather ... provided for a specific pharmaceutical product. The Benefits Verification Specialist will support the healthcare providers addressing questions regarding coding… more
- MyFlorida (Fort Lauderdale, FL)
- INVESTIGATION SPECIALIST II Date: Jan 7, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 844124 Agency: Florida Gaming Control Commission Working Title: INVESTIGATION SPECIALIST II Pay Plan: Career Service Position Number: 41500162 Salary: $44,000… more
- Amgen (Tampa, FL)
- …and transform the lives of patients while transforming your career. **Field Reimbursement Specialist - Florida North** **What you will do** Let's do this. Let's ... change the world. In this vital role the Field Reimbursement Specialist (FRS) will manage defined accounts within a specified geographic region for Patient Access… more
- MetLife (Tampa, FL)
- …customers and our communities. The Senior Long Term Disability (LTD) Claims Specialist evaluates long term disability insurance claims in accordance with plan ... prescribed time service standards. In this role, the Senior LTD Claims Specialist is required to exercise independent judgment, critical thinking skills, exemplary… more
- Owens & Minor (Tallahassee, FL)
- …+ Work with billing and collection teams to assure timely submission of all appeals . + Track and report audit findings and results + Ability to evaluate and ... PA's and medical justification to facilitate payment of claims for initial and review/ appeals payments. + Ability to edit and resubmit claims for payment. + Prepares… more
- Transportation Security Administration (Miami, FL)
- …of movement for people and commerce. Responsibilities This Human Resources Specialist position is located at Miami International Airport (MIA), Transportation ... are consistent with Merit System Principles. Review decision letters regarding appeals and grievance for accuracy prior to delivery. Formulate creative resolutions… more
- Tidelands Health (FL)
- …maintain an industry standard clean claim rate. May assistant with writing appeals letters. Assist with training to include team members and physicians. **Position ... (RHIT(R)) + Certified Professional Coder (CPC) + Certified Coding Specialist (CCS) + Certified Outpatient Coder (COC) **Knowledge/Skills/Abilities** **:** +… more
- Option Care Health (Tallahassee, FL)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are… more
- MetLife (Tampa, FL)
- …and thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. Essential Business Experience and Technical ... Skills: Required: . New hires should live a commutable distance from the site the role is posted in. . Prior experience with independent judgement and decision making while relying on the available facts . Be able to demonstrate the use of critical thinking… more
- MetLife (Tampa, FL)
- …a timely and thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. * Serves as an extended leadership ... team member, participates in new hire onboarding including coaching, mentoring and development, providing direct support to Unit Leaders, and partners with the leadership team to meet project goals related to quality, timely claim outcomes, customer service… more
- MyFlorida (Fort Lauderdale, FL)
- …determinations received from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission. Issues written ... is maintained and available to the Office of RA Appeals for lower level appeals hearings. Required...is an OPS Employment Security Representative II- Employment Review Specialist position in the Department of Commerce's Reemployment Assistance… more
- MyFlorida (Orlando, FL)
- …This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department of Commerce's Reemployment Assistance Programs ... from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission....of RA Appeals and the Reemployment Assistance Appeals Commission. Issues written redeterminations relative to the information… more
- MyFlorida (Tallahassee, FL)
- …This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department of Commerce's Reemployment Assistance Programs ... from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission....of RA Appeals and the Reemployment Assistance Appeals Commission. Issues written redeterminations relative to the information… more
- MyFlorida (Tallahassee, FL)
- …managing construction, Quality Assurance/Quality Control (QA/QC), Contract Management, Appeals , Temporary Housing Assistance Benefit Management, Closeout and other ... the CDBG-DR program and de-obligating funds, when necessary. + The Housing Specialist will provide support to the Housing Manager by conducting eligibility reviews,… more
- University of Miami (Miami, FL)
- …+ Process prescription refills. Process authorizations for medications and procedures. + Process appeals and peer to peer reviews. Assess barriers to care and refers ... Use clinical protocols to refer patients to the appropriate specialist for diagnosis or treatment. + Provide emotional support,...and their families in obtaining referrals to a specific specialist . + Take care of all patient requests. Maintains… more
- Centene Corporation (Tallahassee, FL)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... Coordinate auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical systems + Ability to travel + Performs… more