- Molina Healthcare (Jacksonville, FL)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. **Job Duties** + Prepares written provider overpayment… more
- Sedgwick (Jacksonville, FL)
- …Fortune Best Workplaces in Financial Services & Insurance Sr. Claims Specialist | Medical Malpractice (PL) | Remote , Florida **PRIMARY PURPOSE** **:** ... To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex nature and/or severe injury claims ; to coordinate… more
- Molina Healthcare (Jacksonville, FL)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery which improves encounter submissions, reduces General and Administrative expenses… more
- Molina Healthcare (Jacksonville, FL)
- …review to facilitate a referral to law enforcement or for payment recovery . **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical ... records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines,...+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional… more