Clinical Investigator Behavioral Health Centene Corporation GroupClinical Investigator Behavioral HealthRemote-FL, FLRemote$56,200–$101,000 / yearPosition requires the associate to verify authorization for services and written documentation of services provided against claim information, ensure the appropriateness and accuracy of diagnosis and procedure codes supporting such claims, coordinate medical necessity and appropriate level of care determinations with Medical Directors, and validate services against CMS and State-specific coverage, limitations and exclusion guidelines. 2+ years clinical experience with independent license required; 2 years of fraud, waste, and abuse experience required; experience in provider education and managed care organization preferred; coding certification preferred.
INSURANCE VERIFICATION REPRESENTATIVE Care Resource Community Health Centers, Inc.INSURANCE VERIFICATION REPRESENTATIVEMiami, FLThe Insurance Verification Representative (IVR) is responsible for assisting all Client Service Specialists in processing insurance eligibility for all Care Resource patients, including Medical, Behavioral Health and Dental prior to scheduling appointments. Provides accurate information by identifying and alerting appropriate front desk support staff about patients' financial responsibility, to effectively collect owed money at the time of check in, including past due balances.
Coder Physician OMH HealthEdge Holdings IncCoder PhysicianBoca Raton, FLFounded in 2003, Omega Healthcare Management Services (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear.
Coder HCC OMH HealthEdge Holdings IncCoder HCCBoca Raton, FLFounded in 2003, Omega Healthcare Management Services (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support.
Coder Outpatient OMH HealthEdge Holdings IncCoder OutpatientBoca Raton, FLFounded in 2003, Omega Healthcare Management Services (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear.
Claims & Billing Analyst Independent Living Systems LLCClaims & Billing AnalystMiami, FLILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. The analyst collaborates closely with healthcare providers, insurance companies, and internal departments to verify claims, identify discrepancies, and facilitate timely reimbursements.
Medical Billing Specialist VITAS Healthcare CorpMedical Billing SpecialistMiramar, FLMedical Billing Specialist is responsible for the complete and accurate billing and collections of all hospice claims submitted for payment to third party payers including, but not limited to, Medicare, Medicaid, Managed Care, commercial carriers, and any other state and federal health care programs. Performs all follow up duties associated with rebilling, adjustments, corrected claim submissions and collections of all overdue accounts/claims in accordance with best business practices.
Business Office Coordinator Eldercare Enrollment Mount Sinai Medical Center of FloridaBusiness Office Coordinator Eldercare EnrollmentHialeah, FloridaWe offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Responsible for all activities related to Medicaid enrollment including annual recertification and maintaining Medicare and Medicare benefits while enrolled with Eldercare.
Billing Specialist Coral Connect LLCBilling SpecialistBoca Raton, FLRemoteThe Billing Specialist works closely with intake, prior authorization, cash posting, accounts receivable, clinical, pharmacy, and client teams to ensure accurate claim generation and successful reimbursement outcomes. The Billing Specialist is responsible for the timely and accurate preparation, review, and submission of medical and pharmacy claims for assigned clients across Ambulatory Infusion Centers (AIC), Specialty Pharmacy (SP), and Home Infusion services.
Sr. Patient Accounts Representative (H) University of MiamiSr. Patient Accounts Representative (H)Miami, FLUHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. The Senior Patient Accounts Representative uses advanced knowledge of billing procedures and coding expertise to assist management in the training of staff and in assuring compliance with protocols and regulations.
NewSIU Investigator Centene Corporation GroupSIU InvestigatorFL$56,200–$101,000 / yearCollaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.
X-Ray Technician FoundCareX-Ray TechnicianLake Worth, FLAbility to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms. ESSENTIAL JOB FUNCTIONS: Complete basic x-ray orders as directed by providers using digital x-ray and electronic medical record systems.
Home Health Collection Specialist Integrated HomeHome Health Collection SpecialistMiramar, FloridaAs a Billing and Collect Specialist, you handle patient accounts after medical services have been rendered; liaison between our company and our patients and health plans; verify patient information, obtaining and releasing clinical documentation, appeals/denials, responds to health plan inquiries, process and perform follow-up on aging accounts, generate collection reports, and research and resolve delinquent accounts. Our delivery model is trusted by national Managed Care Organizations (MCOs), physicians and patients, positioned with over two decades of expertise as the market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services.
Trauma Registrar - Per Diem - MRH South Broward Hospital DistrictTrauma Registrar - Per Diem - MRHFort Lauderdale, FLAdditional Job Information: Complexity of Work: Must have knowledge of medical terminology, anatomy and physiology, or coding knowledge; proficiency in utilizing computers; trauma experience; Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), ICD-10 coding familiarity. Works closely with trauma leadership and departments to maintain verification requirements for the organization to drive efficient and effective performance improvement and patient safety process by meticulous data abstraction, injury coding, report writing, and data analysis.
Advanced Inpatient Coder Specialist (REMOTE) BayCare Health SystemAdvanced Inpatient Coder Specialist (REMOTE)FLRemoteResponsibilities: The Medical Records Advanced Inpatient Coding Specialist analyzes the multi day, multi-specialty complex documentation for inpatient encounters to assign integrated diagnosis and procedural code using ICD-10-CM and ICD-10-PCS coding systems. Serves as a liaison to Clinical Documentation Specialist Team and Quality Department for ICD-10 inpatient encounters for accurate code and MSDRG assignments as well as PSI/HAC reviews.
Risk Adjustment Coordinator, Remote, Baptist Health Integrated Care, FT, 08A-4:30P Baptist Health South Florida IncRisk Adjustment Coordinator, Remote, Baptist Health Integrated Care, FT, 08A-4:30PBoca Raton, FLRemote$25.37–$32.22 / hourThe Risk coding Regional Auditor must support the Director of risk coding along with other team professionals working to provide pre and post visit review analysis for provider practices while providing risk coding education to healthcare providers to improve practice risk scores. Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.
Risk Adjustment Coordinator, Hybrid, Palm Beach, Baptist Health Integrated Care, FT, 08A-4:30P Baptist Health South FloridaRisk Adjustment Coordinator, Hybrid, Palm Beach, Baptist Health Integrated Care, FT, 08A-4:30PBoca Raton, FL$25.37–$32.22 / hourThe Risk coding Regional Auditor must support the Director of risk coding along with other team professionals working to provide pre and post visit review analysis for provider practices while providing risk coding education to healthcare providers to improve practice risk scores. Comprehensive Knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
Director, Revenue Cycle Operations Health Business Solutions LLCDirector, Revenue Cycle OperationsCooper City, FLIdentify and implement revenue cycle improvements, using data-driven analysis to reduce claim denials, shorten revenue cycle time, and enhance payment collections. Oversee all functions of the revenue cycle, including patient registration, coding, billing, claims processing, payment posting, denial management, and collections.
Senior Product Manager (PM/RCM) - Full Time - Remote Experity IncSenior Product Manager (PM/RCM) - Full Time - RemoteFLRemote$107,750–$151,400 / yearResponsibilities: Own day-to-day execution of the Revenue Cycle Management product roadmap, ensuring on-time delivery of capabilities across charge capture, coding, claim creation and submission, payer processing, payment posting, denial management, accounts receivable, patient balances, reporting, and related billing workflows. Deep knowledge of healthcare revenue cycle management, including charge capture, coding, claim submission, clearinghouses, payer adjudication, remittance processing, denial management, accounts receivable, and payment posting.
Claims Analyst South Florida Community Care NetworkClaims AnalystSunrise, FLThis role reviews professional and facility claims, identifies payment discrepancies, evaluates claims against benefits, contracts, reimbursement methodologies, and applicable policies, and works with internal teams to resolve issues and improve claims processing. In this role, you'll use your claims expertise and analytical skills to protect payment accuracy, identify opportunities for improvement, and help strengthen the processes that support our members and providers.