- Akumin (Miami, FL)
- The **Biller I, Medical Claims ** is responsible for submitting medical claims to government and private payers. Ensures that service date, CPT code, ... normal workflow. **Specific duties include, but are not limited to:** + Submits medical claims to payers via electronic data interchange (EDI,) paper claims … more
- Molina Healthcare (Miami, FL)
- …business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider ... and benefit configuration, and other claim reimbursement drivers + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Reviews, researches, analyzes and… more
- Molina Healthcare (Miami, FL)
- …sources. **Preferred Qualifications:** + Experience with Medicaid + Experience with medical claims , authorization, and membership data + Advanced proficiency ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- MyFlorida (Fort Lauderdale, FL)
- …Knowledge of Medicaid eligibility, programs, policies, and benefit limitations. Knowledge of medical claims processing and/or health insurance claims ... with or without accommodation. MINIMUM QUALIFICATIONS REQUIREMENTS At least 2 years of medical claims billing experience or 2 years medical claims … more
- Kemper (Miami, FL)
- …investigation experience involving economic or insurance-related matters; or an authorized medical professional to evaluate medical -related claims . + ... Investigator will conduct field and desk investigations of insurance claims referred to and accepted for investigation by the...job is also eligible for our Kemper benefits package ( Medical , Dental, Vision, PTO, 401k, etc.) + This position… more
- Elevance Health (Miami, FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the… more
- Walgreens (Pompano Beach, FL)
- …for billing is completed and accurate prior to claim submission (ie, medical claims billing). + Process reimbursement checks/payment in accordance with ... experience with Walgreens. + Experience in processes related to submitting medical claims , including but not limited to Medicare submission, knowledgeable in EOB… more
- University of Miami (Miami, FL)
- …potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct additional investigation ... federal, and state regulations, and PRO activities to ensure hospital and medical staff activities comply with regulations. + Develops and modifies policies to… more
- Sedgwick (Miami, FL)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Molina Healthcare (Miami, FL)
- …Mathematics, Statistics, or Economics **PREFERRED EXPERIENCE:** Experience working with medical and pharmacy claims , authorization data, benefits design, ... **Job Description** **Job Summary** Provides consultative support and medical cost-based analysis of markets and network initiatives. The Medical Economics… more
- Molina Healthcare (Miami, FL)
- …* Proficiency in Microsoft Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, ... PPO, POS, MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other… more
- University of Miami (Miami, FL)
- …in Miami, FL. Medical coders help to complete, review, and process medical claims to help physician practices and hospitals get reimbursed from insurance ... Trauma, and other specialties that are predominantly invasive codes for medical specialties including Ancillary, Non-Surgical and Surgical services. Has a thorough… more
- Sedgwick (Miami, FL)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner - Workers Compensation **PRIMARY PURPOSE** : To analyze complex or ... technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to… more
- Sedgwick (Miami, FL)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Environmental Claims Specialist **Job Description Summary** To analyze complex or technically ... difficult environmental claims ; to provide resolution of highly complex nature and/or...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Molina Healthcare (Miami, FL)
- …and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department ... retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity… more
- Sedgwick (Miami, FL)
- …Forbes Best-in-State Employer Entry- Level, Bilingual Spanish, Customer Service and Claims Positions **PRIMARY PURPOSE** **:** To expedite the Customer Service ... claims application process; to ensure correct case assignment; and...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- NextEra Energy (Miami, FL)
- ** Claims Agent I** **Date:** Dec 29, 2024 **Location(s):** Miami, FL, US, 33134 **Company:** NextEra Energy is America's largest electric company, providing clean, ... This position is responsible for handling Bodily Injury and Property Damage Claims asserted against the company. The position involves being "on call" which… more
- Fiserv (Coral Springs, FL)
- …an impact on a global scale, come make a difference at Fiserv. **Job Title** Claims Customer Service Associate - Onsite **What does a successful Claims Customer ... experience in a back office administrative environment involving research and issue resolution/ claims and/or disputes. + Two years' experience working in a call… more
- Elevance Health (Miami, FL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Crawford & Company (Sunrise, FL)
- …knowledge of disability contracts, policies, and products and continued understanding of medical and vocational issues. Uses disability claims system for timely ... equivalent experience required. + 2 + years of STD/LTD claims adjudication. + Aptitude for learning medical ...STD/LTD claims adjudication. + Aptitude for learning medical terminology and conditions, as well as interpreting procedures… more