Clinical Coding Analyst RN, Consultant Blue Cross and Blue Shield AssociationClinical Coding Analyst RN, ConsultantMiami, FLIn this role you will be supporting the FCR team in addition to a small clinical coder team of 2 clinical coders who will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes as well as EDC (Emergency Department Coding), MS-DRG and APR-DRG reviews based on clinical determination. Acts as a resource and helps to validate post claim DRG downgrade denials related to coding and clinical determination to support appeal strategy, tracking by disease, payer and denial activity and works with teams to create transparency and improvements to mitigate and prevent denials.
Pain Management Hospitalist (NP or PA) - Tampa Seasoned RecruitmentPain Management Hospitalist (NP or PA) - TampaMiami, FLThe provider will work both independently and collaboratively with physicians, hospital staff, and interdisciplinary teams to manage patients’ acute pain needs and overall treatment plans. Position Overview: This role involves inpatient rounding and pain consult coverage in acute settings at local hospitals in Tampa, Florida.
NewHedis Coordinator FLORIDA DOCTORS GROUP CORPHedis Coordinatorcoral gables, FLFull timeThis position will work directly with providers, medical office staff, health plans, and the FDG internal team to identify and close care gaps, obtain and review medical records, track HEDIS measures, educate provider offices, and ensure appropriate documentation is submitted within required timeframes. The coordinator should develop working knowledge of applicable measures, including areas such as: Preventive Care: Breast Cancer Screening (BCS), Colorectal Cancer Screening (COL), Care for Older Adults (COA), Annual Flu Vaccine, and other age-appropriate preventive services.
Care Facilitator ChenMedCare FacilitatorLauderhill, Florida$14.30–$20.42 / hourUtilizes computer equipment and programs to add new patient information, prints out relevant forms for processing, schedule appointments, respond to emails and generate New Patient packets. Regulates and monitors aspects of transportation, including: Driver’s lists/patients, medication deliveries, grocery deliveries, driver’s behavioral challenges, scheduling and coordinating Uber/Lyft rides for patients.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistMiami, FL$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Inpatient Coder Houston Methodist HospitalInpatient CoderFLHouston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area.
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.
Co-Located Specialty Partner-1 ChenMedCo-Located Specialty Partner-1Carol City, FloridaPrepares patients for examination; assists physician with exams; explains treatment procedures, medications, diet and physicians' instructions to patient; provides disease specific patient education. Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
Licensed Clinical Social Worker Loyal Source Government Services LLCLicensed Clinical Social WorkerHomestead, FLThe contractor shall attend and participate in meetings during normal duty hours, professional staff conferences and other appropriate professional activities such as, but not limited to the following: quality improvement meetings, professional staff meetings, commander''s staff meetings, and other meetings required by applicable regulations or as directed by the unit Commander of his/her designee. The contractor is responsible for the application of social work procedures and techniques, including interviewing, behavioral assessment, and evidenced-based therapies, in the evaluation, diagnosis, and treatment of psychological and neuropsychological disorders using the following skills: individual, family and group psychotherapy, couples therapy, alcohol and drug treatment evaluations.
Patient Services Specialist Cencora IncPatient Services SpecialistFLRemoteProvides integrated services to the health system and its component parts to increase prescription capture rate, ensure timely delivery of infusion medications to be infused in the hospital setting, improve patient outcomes and reduce readmissions. Work experience: This position requires broad training in fields such as Medical Office Administration, Social Work, Medical Records/Billing, Benefit Verification, Patient Financial Services, Pharmacy, Nursing, or similar vocations generally obtained through completion of a 2-year Associate.
Risk Adjustment Coder III Cano Health IncRisk Adjustment Coder IIIMiami, FLThis role performs high-volume, production-based coding and chart review activities, following defined policies and procedures to ensure compliance and data accuracy. Perform detailed chart reviews to ensure accurate capture of diagnoses, including HCC codes, following risk adjustment requirements.
Risk Adjustment Coder Cano Health IncRisk Adjustment CoderMiami, FLThis role performs high-volume, production-based coding and chart review activities, following defined policies and procedures to ensure compliance and data accuracy. Perform detailed chart reviews to ensure accurate capture of diagnoses, including HCC codes, following risk adjustment requirements.
Auditor, ACO Coding Cano Health IncAuditor, ACO CodingMiami, FLThe ACO Coding Auditor is responsible for reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encountering information as it pertains to Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the Medicare Risk score meets all requirements and act as a consulting MRA advisor to the practices you support.
Registration Representative United Surgical Partners InternationalRegistration RepresentativeMIAMI, FLThe Front Desk Clerk interfaces with patients and families, physicians and staff; Admit patients and process their paperwork; Update patient demographics/information in the system; Answer incoming phone calls. Greet patients, check in patients, Filing, answering phones, provides back up support for business office.
Accounting Clerk Builders Capital ExchangeAccounting ClerkFort Lauderdale, FL$50,000–$58,000 / yearWe’re setting ourselves apart by being creative in our financing solutions, leveraging cutting-edge technology, and maintaining an agile, in-house servicing team that ensures quick funding and a smooth process. Builders Capital Exchange is leading the charge in addressing the nationwide housing shortage, with approximately 5 million homes needed to meet demand.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)FL$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
Litigation Paralegal (BI) Kubicki DraperLitigation Paralegal (BI)Miami, FLYour Role: The Miami office of Kubicki Draper is currently seeking a Litigation Paralegal with three or more years of prior Insurance Defense experience. With more than 250 attorneys across 12 offices, we are a trusted leader in trial, appellate, insurance defense, commercial, and real estate litigation.
Client Service Liaison Phaxis LLCClient Service LiaisonMiami, FLresponsible for managing client correspondence, verifying and uploading documents into case management systems, Collect, validate, and upload client documentation into case management platforms. Responsibilities and Duties Deliver high-quality customer service handling incoming and outgoing phone calls with clients.
CLIENT LIAISON/ JR PARALEGAL PhaxisCLIENT LIAISON/ JR PARALEGALMiami, FLresponsible for managing client correspondence, verifying and uploading documents into case management systems, Collect, validate, and upload client documentation into case management platforms. CLIENT LIAISON/ JUNIOR PARALEGAL needed for a long term project at a law firm in downtown Miami (possibility to go perm).
Assistant Seafood Manager Restaurant Depot LLCAssistant Seafood ManagerRoyersford, PA$15.25–$15.76 / hourAdditional Voluntary Supplemental Benefits (may include life insurance, disability coverage, employee assistance programs, and other optional benefits). Support daily seafood department operations to ensure product availability, quality, and presentation.