- Aston Carter (Deerfield Beach, FL)
- Description The Claims Payment Analyst is responsible for reviewing, analyzing and processing claims payment requests for automotive repairs. The ... (may include, but not all encompassing): * Reviewing and processing claims payment requests for automotive repairs. * Determine the appropriate payment… more
- Molina Healthcare (Miami, FL)
- …projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity. + Strong working knowledge of managed care ... Provides lead level support as a highly capable business analyst who serves as a key strategic partner in...focuses on identifying and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy.… more
- Elevance Health (Miami, FL)
- …complex audits. + Participates in pre and post implementation audits of providers, claims processing and payment , benefit coding, member and provider inquiries, ... **Performance Quality Analyst II** **Location:** This role requires associates to...Included are processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Molina Healthcare (Miami, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in...of new and existing health plans. + Executes retroactive claims reports + Runs fee schedule & MRDT update… more
- Molina Healthcare (Miami, FL)
- …education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred ... accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Analyst - Fraud, Waste & Abuse (FWA) provides leadership in in the investigation of potential FWA cases; its main goal is aimed at detection ... with regulatory requirements + Maintain process integrity and ensure legitimate claims are processed efficiently + Implement and track corrective action plans… more
- Molina Healthcare (Miami, FL)
- …deep understanding of Molina claims life cycle and all processes that affect claims payment * Develops and maintain standards and best practices for the team ... Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data… more
- Molina Healthcare (Miami, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that… more
- Molina Healthcare (Miami, FL)
- …emerging technologies. **KNOWLEDGE/SKILLS/ABILITIES** + With limited supervision, the Sr. Analyst , Data is responsible for data compilation, data management, data ... oversee vendor implementations, coordinating data extractions, gathering requirements, supporting payment integrity teams, primarily fraud, waste and abuse. +… more
- Molina Healthcare (Miami, FL)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that… more
- Molina Healthcare (Miami, FL)
- …purposes. **Recoveries & Disputes** + Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and ... care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of… more