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.
Clinical Documentation Improvement Specialist R1 RCM IncClinical Documentation Improvement SpecialistFL$48,131–$81,225.49 / yearHere's what you will experience working as a Clinical Documentation Improvement (CDI) Specialist: Initiates physician interaction when ambiguous, missing, or conflicting information is in the medical record, through the physician query process and/or participation in rounding with the physicians by requesting additional documentation for correct coding and compliance necessary for accurate reflection of CMI, LOS, and optimal resource utilization. Utilizes Hospital coding code set, policies and procedures, Federal and State coding reimbursement guidelines, and application of the Coding Clinic Guidelines to assign working DRG, reviewing patient records throughout hospitalization that have been identified as focus DRG by regulatory agencies or the facility to ensure the codes are reported at the highest specificity.
Clinical Document Integrity Specialist 1, Managed Care Network Development Med Mgmt, FT, 8:30A-5P Baptist Health South Florida IncClinical Document Integrity Specialist 1, Managed Care Network Development Med Mgmt, FT, 8:30A-5PMiami, FL$71,940.93–$93,523.21 / yearKnowledge of legal aspects of coding; Medicare MS-DRG and Medicaid APR-DRG assignment; severity of illness, risk of mortality; documentation integrity, utilization, quality, and case management, discharge planning, managed care, and denial prevention preferred. 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.
Business Systems Analyst, Revenue Integrity University of MiamiBusiness Systems Analyst, Revenue IntegrityMiami, FLAnalyzes existing flow of people, activities, and materials, employee work methods and utilization, policies and procedures, staffing levels, supervisory structure, space utilization, supply and demand optimization methods, forms, equipment, and computerized systems to design improved work systems. The Business Systems Analyst, Revenue Integrity collects detailed data and provides analysis to assist in the development of technology plans and strategies that enhance overall performance, reduce costs, and increase efficiencies.
Auditor, Risk Adjustment Oscar HealthAuditor, Risk AdjustmentMiami, FLRemote$82,717–$108,566 / yearResponsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts. Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
RCM Supervisor PROMD PRACTICE MANAGEMENT INCRCM SupervisorPinecrest, FLFull timeThis role supervises billing, collections, payment posting, denial management, and accounts receivable teams to ensure clients achieve optimal reimbursement, reduced A/R days, and high clean-claim rates. The RCM Supervisor serves as a key liaison between clients, payers, providers, and internal teams, ensuring service excellence and compliance with industry regulations.
Certified Risk Adjustment Coder Mount Sinai Medical Center of FloridaCertified Risk Adjustment CoderHialeah, 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. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.
Clinical Document Integrity Specialist 1, Managed Care Network Development Med Mgmt-Baptist Main, FT, 8:30A-5P Baptist Health South FloridaClinical Document Integrity Specialist 1, Managed Care Network Development Med Mgmt-Baptist Main, FT, 8:30A-5PMiami, FL$71,940.93–$93,523.21 / yearKnowledge of legal aspects of coding; Medicare MS-DRG and Medicaid APR-DRG assignment; severity of illness, risk of mortality; documentation integrity, utilization, quality, and case management, discharge planning, managed care, and denial prevention preferred. Responsible for improving the overall quality and completeness of clinical documentation through concurrent review of inpatient records to support accurate code assignment, severity of illness and risk of mortality capture, quality outcomes, and appropriate reimbursement.
Research Registry Abstractor Urology Mount Sinai Medical Center of FloridaResearch Registry Abstractor UrologyMiami Beach, FloridaLicense/Registration/Certification Preferred: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), or Active CITI Program certification in Human Subjects Research. We 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.
NewPATIENT FINANCIAL SERVICES SPECIALIST II Community Health of South Florida Inc.PATIENT FINANCIAL SERVICES SPECIALIST IIMiami, FLCoordination of work from the patient care areas, maintaining the work flow of documents to and from data processing and supervising closing by staff. Plans, supervises and coordinates the work of Patient Financial Services Specialist staff and supporting clerical staff in various Departments.
Billing Coordinator - Peds Cardiology (Full Time, Days) Nicklaus Children's HospitalBilling Coordinator - Peds Cardiology (Full Time, Days)Miami, FLProvides solutions to patients/patient families and frequently assists the billing company to ensure correct charge posting and correct collection follow-up. Gathers billing document, follows up with Leader when no charges are received, and reviews billing document for CPT and ICD-9 codes.
Senior Cloud Engineer Hybrid @ Bellevue, WA or Remote @ Florida OfferUp IncSenior Cloud Engineer Hybrid @ Bellevue, WA or Remote @ FloridaFLRemote$215,000–$240,000 / yearOne of the top local marketplace apps for local buyers and sellers in the U.S., OfferUp makes it easy for people to discover more of what they need-from great deals and secondhand goods to jobs, services, home rentals, and more-right in their own communities. Keep the SDLC fast and safe - build CI/CD pipelines and developer workflows (GitHub Actions, monorepo tooling, JFrog Artifactory), and maintain the backend "golden templates" and shared libraries the wider org builds on.
NewCare Pathway Program Manager Nicklaus Children's HospitalCare Pathway Program ManagerMiami, FLThe Program Manager role supports value-based care (VBC) initiatives and specialty programs by establishing the operational infrastructure, workflows, performance metrics, and reporting mechanisms necessary to achieve quality, utilization, and financial goals. Oversees care pathways performance, supports HEDIS and other quality reporting initiatives, ensures accurate patient attribution and panel management, and translates contractual and regulatory requirements into actionable workflows and clinical processes.
Team Leader Data and Systems HIM Medical Records Mount Sinai Medical Center of FloridaTeam Leader Data and Systems HIM Medical RecordsMiami Beach, FloridaAssist in Daily Chart Reconciliation & Workflow Coordination: Monitor and log daily patient discharge lists to reconcile all incoming medical records, follow up on missing charts with clinical units, compile and distribute daily suspension and status letters, and assign staff tasks for document prep, scanning, and indexing into OneContent. Monitor physicians incomplete record activity, including notifying physicians of incomplete records until records are completed for release of information purposes and to assist coding staff obtain necessary clinical documentation for coding and reimbursement purposes.
Patient Care Assistant- BH Care Resource Community Health Centers, Inc.Patient Care Assistant- BHMiami, FLAssist Medical Providers with medical procedures/testing by performing: Electrocardiogram (EKG's), vision and hearing test, diabetic, foot/monofilament test, fall risk assessment (65 & over), waived testing, results documentation & log Maintenance (blood glucose, A1C, strep, urine dipstick, urinalysis, pregnancy, Immunochemical Fecal Occult Blood Test (iFOBT), influenza A&B). Assist Medical Providers with procedures/testing and ensures proper documentation in medical record: Pap smear, colposcopy, biopsy, vaginal cultures, pelvic/breast exam, male exam, incision and drainage, throat cultures, nebulizer treatments and other procedures as indicated by the provider.
Senior Software Developer Jazwares CareersSenior Software DeveloperPlantation, FloridaRemoteExperience with Agile/Scrum methodologies, TypeScript, HTMX, AWS services (Lambda, EC2, S3, RDS, Cloud Watch, IAM), integrating AI/ML models or APIs into applications, serverless architecture and micro services patterns. The Senior Software Developer will collaborate with cross-functional teams to design, develop, and implement innovative applications, while also mentoring and providing technical guidance to junior developers.
NewLead Software Engineer - AI Humana IncLead Software Engineer - AIFort Lauderdale, FL$129,300–$177,800 / yearExercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Clinical and Product Partnership: Collaborate closely with product managers, designers, clinicians, and data stakeholders to understand care delivery workflows and translate them into well-scoped, high-impact AI features.
Utilization Review Nurse Health Business Solutions LLCUtilization Review NurseCooper City, FLThe Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. Care Coordination : Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
Account Executive/Client Success Manager - Behavioral Health MedusindAccount Executive/Client Success Manager - Behavioral HealthMiami, FloridaRemote$60,000–$90,000In January 2023, Alpine Investors, a people-driven private equity firm, invested in Medusind to continue to advance its leadership position as one of the top revenue cycle management companies in the country. Technical skills: Advanced proficiency in RCM software and Microsoft Office Suite, including strong Excel skills (pivot tables, formulas, data analysis, and reporting).
Sr. Software Engineer (C# .NET/Azure/React/API's Kafka and Kubernetes) INSPYR SolutionsSr. Software Engineer (C# .NET/Azure/React/API's Kafka and Kubernetes)Davie, FLRemote$70–$75 / hourInformation collected and processed through your application with INSPYR Solutions (including any job applications you choose to submit) is subject to INSPYR Solutions’ Privacy Policy and INSPYR Solutions’ AI and Automated Employment Decision Tool Policy: https://www.inspyrsolutions.com/policies/ . As a leading information technology partner, we connect top IT talent with our clients to provide innovative business solutions through our IT Staffing, Professional Services, and Infrastructure Solutions divisions.