- Molina Healthcare (FL)
- …Coordination of Benefits experience. + Experience with **_BPaaS solutions_** and Medicaid Managed Care programs. + Strong understanding of **_SQL and relational ... optimizing operational process designs, setting procedural standards, and overseeing vendor operations to ensure compliance with key performance indicators (KPIs)… more
- Molina Healthcare (Orlando, FL)
- …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Health First (Rockledge, FL)
- …Microsoft SQL Server, and Oracle. o Business knowledge of key managed care functions including specific knowledge of claims , enrollment, and premium business ... as well as PMO related project assignments. 8. Manage vendor relationship through communication with external vendor 's...ETL platforms and tools such as Azure Data Factory, Managed File Transfers, SFTP, PGP, and basic networking o… more
- Humana (Tallahassee, FL)
- …7+ years of related compliance and/or special investigation experience in managed care or CMS. + Prior health insurance claims experience + Demonstrated ... Attend federal CMS and state fraud meetings with other managed care organizations, as well as state...exciting interviewing technology provided by Modern Hire, a third-party vendor . This technology provides our team of recruiters and… more
- HealthEdge Software Inc (Tallahassee, FL)
- …Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care , and commercial payment methodologies, payment integrity, and ... and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application. + Working knowledge… more
- Takeda Pharmaceuticals (Tallahassee, FL)
- … Vendor Management + Oversight and accountability for labeling activities managed by external vendor (s) for assigned products, ensuring seamless coordination, ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- AssistRx (Lockhart, FL)
- …specialty pharmacy with medication assistance, prior authorizations, pharmacy benefits investigation, managed care , claims processing. + Experience working ... with pharmaceutical or biotech companies. + 5 years of progressive health care business experience (SPP, hospitals, or insurance). + Computer skills including… more