- Molina Healthcare (St. Petersburg, FL)
- null Pay Range: $21.16 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
- Sedgwick (Tampa, 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 (St. Petersburg, FL)
- …Qualifications * At least 3 years clinical nursing experience in claims auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization ... Information Technician (RHIT) or Registered Health Information Administrator (RHIA). * Claims auditing, quality assurance, or recovery auditing, ideally in… more
- Molina Healthcare (St. Petersburg, 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 (St. Petersburg, 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