Current jobs related to Claims Adjudicator - Miami - Miami Jewish Health
-
Claims Adjudicator
4 weeks ago
Miami, Florida, United States SNI Companies Full timeJob Title: Claims AdjudicatorSeeking an experienced Claims Adjudicator to join our team at SNI Companies.Job Summary:This role is responsible for adjudicating medical and non-medical provider claims, ensuring accurate capitation reimbursement from Medicaid and Medicare.The successful candidate will be key to our revenue and expense process, procuring...
-
Medical Claims Adjudicator
3 weeks ago
Miami, Florida, United States SNI Companies Full timeJob Summary We are seeking a skilled Medical Claims Adjudicator to join our team at SNI Companies. As a key member of our revenue and expense process, you will be responsible for adjudicating medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. This position is crucial to our organization's success,...
-
Claims Adjudicator
2 months ago
Miami, United States SNI Companies Full timeJob Summary This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMSPosition is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for...
-
Medical Claims Adjudicator
3 weeks ago
Miami, United States Staffing Now Full timeJob SummaryThis position is primarily responsible for reviewing and processing medical and non-medical provider claims, ensuring accurate reimbursement from Medicaid and Medicare. The role is critical to the revenue and expense process, requiring strong analytical and communication skills.Key Responsibilities* Review and adjudicate medical claims, including...
-
Medical Claims Adjudicator
1 month ago
Miami, United States Staffing Now Full timeJob Summary This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to all revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for...
-
Medical Claims Adjudicator
1 month ago
Miami, United States SNI Companies Full timeJob Details Job Summary This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client...
-
Medical Claims Adjudicator
3 weeks ago
Miami, FL, United States Staffing Now Full timeJob Summary This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to all revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for...
-
Medical Claims Examiner
4 weeks ago
Miami, United States Staffing Now Full timeJob SummaryThis position plays a critical role in the revenue and expense process, ensuring accurate capitation reimbursement from Medicaid and Medicare. The Medical Claims Adjudicator will be responsible for adjudicating all medical and non-medical provider claims, submitting enrollments and disenrollments to Florida Medicaid and CMS, and generating...
-
Medical Claims Examiner
3 weeks ago
Miami, Florida, United States Insight Global Full timeJob SummaryWe are seeking a skilled Medical Claims Examiner to join our team at Insight Global. As a Medical Claims Examiner, you will be responsible for analyzing and adjudicating routine claims, determining approval on file, eligibility, identifying discrepancies, and applying all cost containment measures to assist in the claim adjudication process.Key...
-
Insurance Claims Examiner
3 weeks ago
Miami, Florida, United States Staffing Now Full timeClaims Adjudication RoleWe are seeking a detail-oriented Claims Adjudication Specialist to review, process, and resolve insurance claims at Staffing Now.Key Responsibilities:Review and analyze insurance claims to ensure compliance with company policies and guidelines.Communicate with claimants and healthcare providers to resolve claims efficiently.Maintain...
-
Insurance Claims Examiner
4 weeks ago
Miami, Florida, United States Staffing Now Full timeClaims Adjudicator OpportunityWe are seeking a detail-oriented Claims Adjudicator to review, process, and resolve insurance claims. Key Responsibilities:Review and analyze insurance claims to ensure compliance with company policies and guidelines.Communicate with claimants and healthcare providers to resolve claims efficiently.Maintain accurate records of...
-
Senior Claims Examiner
4 weeks ago
Miami, Florida, United States PayerFusion Holdings LLC Full timeAbout UsPayerFusion Holdings LLC is a service-based company that excels in delivering innovative solutions to the healthcare industry.We're seeking a top talent and experienced Claims Processor Specialist to join our team and help us meet and exceed our client's expectations.Job DescriptionAs a Claims Processor Specialist, you will be responsible for...
-
Insurance Claims Examiner
4 weeks ago
Miami, Florida, United States SNI Companies Full timeJob Title:Claims AdjudicatorLocation:Little Haiti, Miami, FLPay:$20 per hour Monday - Friday 8:30am - 5PMWe are seeking a detail-oriented Claims Adjudicator to review, process, and resolve insurance claims.Key Responsibilities:Review and analyze insurance claims.Communicate with claimants and healthcare providers.Ensure compliance with company policies and...
-
Insurance Claims Examiner
4 weeks ago
Miami, Florida, United States SNI Companies Full timeJob Title: Claims AdjudicatorLocation: Miami, FLPay: $20 per hour Monday - Friday 8:30am - 5PMWe are seeking a detail-oriented Claims Adjudicator to review, process, and resolve insurance claims.Key Responsibilities: Review and analyze insurance claims. Communicate with claimants and healthcare providers. Ensure compliance with company policies and...
-
Medical Claims Examiner
4 weeks ago
Miami, United States SNI Companies Full timeJob SummaryThis position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. The position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for...
-
Miami, Florida, United States PayerFusion Full timeAbout PayerFusionWe are a service-based company and a licensed third-party administrator seeking top talent and experienced personnel to meet and exceed client expectations. Our innovative approach creates a unique experience for healthcare professionals.We're looking for a highly qualified Claims Examiner for in-person on-site work. The ideal candidate has...
-
Medical Claims Examiner
4 weeks ago
Miami, FL , USA, United States SNI Companies Full timeJob Title: Medical Claims AdjudicatorJob Summary:This position is responsible for the accurate and timely adjudication of medical and non-medical provider claims, as well as the submission of enrollments and disenrollments to Florida Medicaid and CMS. The successful candidate will play a key role in PACE's revenue and expense process, ensuring compliance...
-
Medical Claims Examiner
4 weeks ago
Miami, Florida, United States Staffing Now Full timeJob SummaryThis position is primarily responsible for ensuring the accurate and timely processing of medical and non-medical provider claims, as well as submitting enrollments and disenrollments to Florida Medicaid and CMS. The successful candidate will play a key role in the revenue and expense process, procuring Medicare rate tables, processing provider...
-
Claims Manager
2 months ago
Miami, United States AppleOne Employment Services Full timeWe are looking to hire a Claims Manager in the Coral Gables, FL area. This is an on-site position available with one of our best clients in the insurance services industry.In this role, you will supervise and manage day-to-day claims operations, ensuring quality and compliance with industry standards and state regulations. Your leadership will be crucial in...
-
Claims Manager
1 month ago
Miami, United States AppleOne Employment Services Full timeWe are looking to hire a Claims Manager in the Coral Gables, FL area. This is an on-site position available with one of our best clients in the insurance services industry.In this role, you will supervise and manage day-to-day claims operations, ensuring quality and compliance with industry standards and state regulations. Your leadership will be crucial in...
Claims Adjudicator
2 months ago
Miami Jewish Health is a leading provider of healthcare and living options for aging adults in the Southeast. We are seeking a skilled Claims Adjudicator to join our team.
Job SummaryThis position is responsible for adjudicating medical and non-medical provider claims, submitting enrollments and disenrollments to Florida Medicaid and CMS, and ensuring accurate capitation reimbursement from Medicaid and Medicare.
Key Responsibilities- Adjudicate medical claims, including tracking claims, verifying referrals and authorizations, and generating remittance notices.
- Obtain DDE rates not loaded into the claims system and work with IT for upload.
- Coordinate with IT to transmit batch claims to accounts payable.
- Adjudicate non-medical claims, including verifying claims and incidental charges, and researching questionable bills.
- Prepare Omnicare Pharmacy billing for site nurses to review utilization and make necessary adjustments.
- Attend weekly intake meetings to verify status on upcoming enrollments and disenrollments.
- Prepare and submit monthly expense accruals to Accounting.
- Participate in department meetings and in-services as necessary.
- High school diploma or equivalent; Associates Degree preferred.
- Minimum two years of experience in claims adjudication for community service programs.
- Knowledge of Windows, Microsoft Outlook, Excel, and Word.
- Excellent organizational and communication skills.
- Ability to work independently and as part of a team.
- Knowledge of healthcare regulations and policies.
- Ensure confidentiality and security of patients' medical information.
- Adhere to the organization's Mission, Vision, and Values.
- Participate in departmental activities, meetings, and in-services.
Miami Jewish Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
