Medicaid Clinical Review jobs in Palm Harbor, FL

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Director of Clinical Reimbursement (MDS)
Facility Support Company, LLC - Clearwater, FL 33756
Comprehensive knowledge of Medicare and Medicaid reimbursement. 3 years of Clinical Reimbursement/Minimum Data Set experience - *REQUIRED*....
Easily apply
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Claims Coding Specialist
WellCare - 561 reviews - Tampa, FL 33634
Review medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim...
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Sr. Recovery Resolutions Analyst for M&R Clinical Waste and...
Recovery Resolutions Analyst for M&R Clinical Waste and Error will work with a team on researching physician medical records to ensure correct coding of medical...
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Director of Clinical Reimbursement (MDS)

Facility Support Company, LLC - Clearwater, FL 33756
Comprehensive knowledge of Medicare and Medicaid reimbursement. 3 years of Clinical Reimbursement/Minimum Data Set experience - *REQUIRED*....
Easily apply

Expedited Claims Appeals Representative - Oldsmar, FL

UnitedHealth Group - 4,138 reviews - Oldsmar, FL 34677
Review, research and understand how an authorization submitted by consumers and physicians/providers was processed and determine why it was deniedIdentify and...

Senior Clinical Services Specialist

WellCare - 561 reviews - Tampa, FL 33634
Reviews all programs assigned and continuously ensure they meet the rigorous standards that are set forth by WellCare's clinical services department....

Therapist

The Children's Home, Inc. - Tampa, FL
Attends and participates in all treatment plan reviews, psychiatric consultations, internal/external utilization meetings, and/or any client review meetings...
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Nurse Auditor

Freedom Health - 29 reviews - Tampa, FL 33614
Clinical Review Nurse- Adverse Determinations. Conducts accurate and thorough medical record reviews in order to apply clinical knowledge and plan-approved...

Care Advocate

Rogers Memorial Hospital - 36 reviews - Tampa, FL 33607 (Carver City area)
Extensive knowledge of managed care, Medicaid and Medicare. Utilization review experience in a hospital, outpatient or managed care setting....

PAYMENT SPECIALIST

University of South Florida Health - Tampa, FL
Work directly with Billing Specialists to resolve incorrect reimbursements from Medicare and Medicaid. Review of insurance payment amounts to determine if...

Medical Office Manager - Palm Harbor

In Health MD Alliance - Palm Harbor, FL  +1 location
Reviews all monthly HEDIS and MRA Reports. Address employee’s issues in a timely fashion and perform Employee Performance reviews....
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Regional Director, Managed Care

Surgery Partners - Tampa, FL 33609 (Swann Estates area)
Review and negotiate contract language. Educate ASC / Clinical internal staff on managed care issues, trends, etc. Managed Care Department....

Residential Services Director

The Children's Home, Inc. - Tampa, FL
Reviews all internal and external incident reports. Collaborates with Clinical Director regarding accepting new youth and ensuring quality activities and...
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Medical Director for Managed Care
Is seeking a Medical Director for our Managed Care Division-Medicare Advantage and Medicaid HIV/AIDS Special Needs Health Plans....
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