- Molina Healthcare (Tampa, FL)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Travelers Insurance Company (Tampa, FL)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- USAA (Tampa, FL)
- …Medicare-related claims . + Expert Advice: Ability to review complicated medical records and medical claims , and provide expert advice. Conducts ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...review of complex healthcare fraud investigations and providing claims support + Medical Coding Proficiency: At… more
- Elevance Health (Tampa, FL)
- …+ Travels to worksite and other locations as necessary. + BA/BS preferred. + Medical claims review with prior health care fraud audit/investigation ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Tampa, FL)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Tampa, FL)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Elevance Health (Tampa, FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Veterans Affairs, Veterans Health Administration (Tampa, FL)
- …and team player who is adaptable to the needs of a growing medical center. Board certification in Emergency Medicine highly preferred. Responsibilities This position ... are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. VA… more
- MyFlorida (Tampa, FL)
- …but are not limited to fraud against the Medicaid Program, false claims against the Medicaid program, investigating possible criminal violations of any applicable ... by a licensed physician, physician assistant, or licensed advanced practice registered nurse , based on specifications established by the commission. In order to be… more