Medical Claim Analyst
4 weeks ago
- Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries.
- Performs hospital length of stay reviews to determine reasonable and necessary care, and appropriateness of stay. Recommends appropriate payments of dispute of billing, as necessary.
- Provides second review of bills on which providers question the appropriateness of payments authorized.
- Evaluates claims referred for medical management and makes recommendations for follow-up, further investigation or documentation as necessary.
- Trains and assists claims staff on quality health care cost containment and utilization reviews.
We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.Company DescriptionLeading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down.\r
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We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.
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Claims & Rejections Senior Analyst
3 days ago
Miami, United States Del Monte Fresh Produce Company NA Inc Full timeJob DescriptionJob DescriptionPurpose of Position:This role will be a key member of NA finance team and financial business partner for the business operations. This position will be responsible for overseen several functions/Processes on the NA Accounting department for assigned locations/processes within the region. In this role, the position will also be...
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Claims Representative
2 weeks ago
Miami, United States Norwegian Cruise Line Holdings Ltd. Full timeBASIC PURPOSE: Research, review, investigate and adjust claims for personal injury or other complaints made by passengers.POSITION RESPONSIBILITIES:Performs in-house adjustment of passenger personal injury and other claims. Reviews documentation, conducts research/investigation, evaluates, negotiates and resolves claims in accordance with contracts,...
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Claims Representative
2 weeks ago
Miami, United States Norwegian Cruise Line Holdings Ltd. Full timeBASIC PURPOSE: Research, review, investigate and adjust claims for personal injury or other complaints made by passengers.POSITION RESPONSIBILITIES:Performs in-house adjustment of passenger personal injury and other claims. Reviews documentation, conducts research/investigation, evaluates, negotiates and resolves claims in accordance with contracts,...
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Claims Adjuster
1 day ago
Miami, United States Sentara Healthcare Full timeCity/State Doral, FL Overview Work Shift First (Days) (United States of America) AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Claims Adjuster in Miami and/or Gainesville, Florida. This is a hybrid position, 2 days in office and 3 days remote. Scope of position: The Claims Adjuster is responsible for performing centralized...
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Associate Claims Adjuster
4 weeks ago
Miami, United States Assurant Full timeAssurant protects what matters most to people in completely new ways, so you can create experiences that make your customers day. We are looking for an **Insurance Adjuster** to begin a career at Assurant in a fast-paced, energetic environment where you drive results while providing exceptional customer service. At Assurant, we are all about opportunity and...
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Miami, United States The Verdecia Law Firm Full timeJob DescriptionJob DescriptionWe are seeking a motivated Claims Manager/Legal Assistant to become a part our team. As a claims manager/paralegal you will be responsible for interacting with clients and providing great customer service, opening physical files, opening and handling claims process, and provide support to the attorneys in the office. This...
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Medical Billing
3 weeks ago
Miami, United States Ortopedia Cubana Y Clinica Del Pie Full timeJob DescriptionJob DescriptionMedical Biller with Experience in Electronic Claims Medical Billing & Payment Posting of Claims, Process Collection for Denial of Claims, Knowledge of CPT and ICD-10 coding. for an Orthotics and Prosthetics Company Preferred, Bilingual is important.Company DescriptionWe are an O & P Medical Company, we service patients for...
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Benefits and Compensation Analyst
7 days ago
North Miami Beach, United States Benihana Full timeDescription Position at Benihana Position Summary: The Benefits and Compensation Analyst under general supervision of the Benefits Manager is responsible for the daily interpretation and administration of the Company's benefits and company-sponsored programs in regard to plan options, policy features, enrollment, and other requirements. S/he also supports...
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Sr. Business Analyst
2 weeks ago
Miami, United States Alivi Full timeJob DescriptionJob DescriptionJOB SUMMARY: The business intelligence analyst will conduct thorough data analysis, design, and implement analytic programs, generate reports, and collaborate with various teams to ensure we have the data necessary to optimize our resources, product performance and maximizing our market share. To succeed in this position, you...
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Sr. Business Analyst
2 hours ago
Miami, United States Alivi Full timeJob DescriptionJob DescriptionJOB SUMMARY: The business intelligence analyst will conduct thorough data analysis, design, and implement analytic programs, generate reports, and collaborate with various teams to ensure we have the data necessary to optimize our resources, product performance and maximizing our market share. To succeed in this position, you...
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Medical Billing and Collections
3 weeks ago
Miami, United States Revenue Cycle Management Profession Full timeJob DescriptionJob DescriptionFast paced Medical Billing company looking for experienced Medical Billing and Insurance Collector ( >2 years). Must have knowledge of medical appeal guidelines, including Medicare. Need to be proficient with ICD-10 and coding guidelines. Good benefits such as; paid vacation, paid holidays, 401K, health benefits .Job Type:...
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American Export Intern
14 hours ago
Miami, United States Mondelēz International Full timeCreate catalogs with variable logistics, shelf life, and product images. Support in following orders: Track customer Purchase Orders vs. forecast. Sending reminders to the clients to receive the Purchase Orders in the first 2 weeks of the month Review and follow up on deductions and claims with the customer and customer service coordinator/claim...
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American Export Intern Miami-based
2 days ago
Miami, Florida, United States Mondelēz International Full timeCreate catalogs with variable logistics, shelf life, and product images.Support in following orders: Track customer Purchase Orders vs. forecast.Sending reminders to the clients to receive the Purchase Orders in the first 2 weeks of the monthReview and follow up on deductions and claims with the customer and customer service coordinator/claim...
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Board Certified Behavior Analyst
2 weeks ago
Miami, United States Pedikidz of Florida Full timeCompany Description Pedikidz of Florida is a specialized daycare located in Miami, FL, that provides care for medically complex children who depend on technology, therapies, and devoted care. Our philosophy is to provide impeccable care, compassion, and help children become the best version of themselves. We have a dedicated staff that embraces this...
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Board Certified Behavior Analyst
2 weeks ago
Miami, United States Pedikidz of Florida Full timeCompany Description Pedikidz of Florida is a specialized daycare located in Miami, FL, that provides care for medically complex children who depend on technology, therapies, and devoted care. Our philosophy is to provide impeccable care, compassion, and help children become the best version of themselves. We have a dedicated staff that embraces this...
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Risk Management
5 days ago
Miami, United States Norwegian Cruise Line Holdings Ltd. Full timeJOB SUMMARY: Identify and analyze passenger and crewmember shipboard risks as part of confidential investigation of incidents/claims in anticipation of litigation at the direction of legal counsel. Liaise directly with counsel regarding findings/trends.DUTIES & RESPONSIBILITIES:On a daily basis review incident data to identify potential risks.Prioritize...
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Risk Management
5 days ago
Miami, United States Norwegian Cruise Line Holdings Ltd. Full timeJOB SUMMARY: Identify and analyze passenger and crewmember shipboard risks as part of confidential investigation of incidents/claims in anticipation of litigation at the direction of legal counsel. Liaise directly with counsel regarding findings/trends.DUTIES & RESPONSIBILITIES:On a daily basis review incident data to identify potential risks.Prioritize...
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Medical Biller Coder
3 weeks ago
South Miami, United States Steven R Poliakoff MD PL Full timeJob DescriptionJob DescriptionWe are looking for an experienced medical coder and biller familiar with cms 1500 form billing. Able to do appeals for insurance denials, computer literate, experienced with Availity and claims tracking computer systems. We are an OB/GYN office so experience with gynecological terminology preferred, but not required.
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Benefits Analyst
1 week ago
North Miami Beach, United States Turnberry Full timeCompany Overview: Turnberry is a leader in the design, development, and management of multi-use real estate properties. We create exceptional destinations that inspire how people live, work, and play. Our portfolio of projects is diverse: retail hubs and shopping centers that anchor communities and offer an experience on par with a visit to a world-class...
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Medical Assistant Neurology
4 weeks ago
Miami, Florida, United States Nicklaus Children's Health System Full timeJob SummaryAssists in examinations and treatment of patient's care under the direction of the physician and/or clinician. Supports patient care management by performing various administrative functions. Job Specific DutiesAnswers telephones, routes calls, takes, and relays accurate phone messages. If applicable, prepares and administers...