- Molina Healthcare (Miami, FL)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Canon USA & Affiliates (Tallahassee, FL)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- AdventHealth (Maitland, FL)
- …sources using knowledge of healthcare managed care contracts and healthcare administrative claims data + Employs existing complex models and implements them ... to the team:** + Research and analyzes managed care data from the various financial systems and...provider types + Applies detailed understanding of medical coding systems affecting the adjudication of claims to… more
- Cushman & Wakefield (Clearwater, FL)
- **Job Title** Sr . Facilities Manager **Job Description Summary** This position has managerial oversight of multiple facilities, an entire campus, or a portfolio of ... Facilities Manager and/or Assistant Facilities Manager reporting into it. The Senior Facilities Manager has the overall responsibility for overseeing the… more
- Publix (Lakeland, FL)
- …and ad-hoc reporting identifying operational fluctuations in account balances and/or transactional data within the various Pharmacy systems to ensure accuracy ... **33247BR** **Position Title:** Sr . Collections Specialist - Pharmacy - Lakeland **Department:** Finance **Location:** Lakeland, FL **Description:** The Senior … more
- Sumitomo Pharma (Tallahassee, FL)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Tallahassee, FL)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Gilead Sciences, Inc. (Tampa, FL)
- …Join Gilead and help create possible, together. **Job Description** As a ** Sr ** **Therapeutic Specialist** you are responsible for representing Gilead's products and ... other team members, and acts as a mentor for junior staff. + Initiates systems to regularly measure sales progress and action plans. Documents and provides feedback… more
- Evolent (Tallahassee, FL)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- Evolent (Tallahassee, FL)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (St. Petersburg, FL)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Evolent (Tallahassee, FL)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- GE Aerospace (Jacksonville, FL)
- …aftermarket customers, Unison designs, manufactures and supplies the most advanced components and systems in the world. As a Senior Sourcing Commodity Manager, ... to Procurement and ensure seamless communication across teams. + Manage supplier claims and resolve issues to maintain strong supplier relationships. + Perform… more
- CHS (Clearwater, FL)
- …medical necessity and appropriateness, eligibility and coordination of benefits + Documents fully claims referred to senior staff for review and determination + ... **Overview** **Health Insurance Medical Claims Examiner** **(Initial Training On Site - 90...work independently + Knowledge of medical and dental coding systems + Knowledge of medical terminology **Qualifications** **Qualifications:** +… more
- Highmark Health (Tallahassee, FL)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- LogixHealth (Dania, FL)
- Location: On-site in Dania, Florida This Role: The Senior Systems Support Analyst's role is to ensure consistent deployment and stable operation of the corporate ... systems , network, and security posture. This involves supporting, planning,...version-control and modern deployment practices + Understanding of applicable data privacy practices and laws + Exceptional problem-solving skills… more
- Molina Healthcare (FL)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- ChenMed (Miami, FL)
- …economics data such as hospital/physician /ASC claims , utilization data , and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, ... we need great people to join our team. The Senior Health Economics Analyst is responsible for identifying and...JOB DUTIES/RESPONSIBILITIES:** + Analyzes and interpret enrollment, revenue, and claims (utilization and unit cost) data to… more
- Molina Healthcare (FL)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …Operational Support will be responsible for managing and enhancing platform integrations across data systems , Salesforce Health Cloud and other CRM systems , ... and related CRM system integrations with internal and external systems , data platforms, and analytics solutions. +...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more