Top 291 Medical claims Jobs in Miami, Fl

Healthcare Claims and Fee for Service Supervisor
Provider Network Solutions LLC —Miami, FL
- $63,000 - $65,000 a year
- Full-time
- 5 years
- HIPAA
- Bachelor's degree
Quick Apply
9d
Medical Collector/radiology
Radiologic PL —Miami, FL
- $25 - $35 an hour
- Full-time
- Spanish
- English
- Supervising experience
Quick Apply
1d
Medical Biller
Clinicare Medical Center —Miami Beach, FL
- $15 - $20 an hour
- Full-time
- Spanish
- English
- Mid-level
- Paid time off
Quick Apply
Credentialing Specialist
OnSpot Dermatology —Fort Lauderdale, FL
- $25 an hour
- Full-time
- Mid-level
- Organizational skills
- Contracts
Quick Apply
Manager Social Work & Care Management, Case Management, FT,9A-5:30P
Baptist Health South Florida —Miami, FL
- $91,132.84 - $118,472.69 a year
- Full-time
- Hospital
- 5 years
- Licensed Clinical Social Worker
- Wellness program
- Health insurance
Government Claims Admin 2, Remote
Baptist Health South Florida —Miami, FL
- $20.62 - $26.19 an hour
- Remote
- High school
- Medical office experience
- High school diploma or GED
- Wellness program
- Health insurance
2d
Administrative Assistant for Home Health Agency
Luna Home Care Services Inc —Kendall, FL
- $20 - $35 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Paid time off
- Flexible schedule
Quick Apply
9d
Sr. Medical Biller (H)
University of Miami —Medley, FL
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
Medical Biller – In-Person / In-House
Energy Medical Center —Hialeah, FL
- $28 - $30 an hour
- Full-time
- Primary Care
- HIPAA
- English
Quick Apply
10d
Remote ABA Therapy Medical Billing Specialist
House of Hearts ABA —Hollywood, FL
- $20 - $28 an hour
- Part-time
- Remote
- Bachelor's degree
- Children
- Organizational skills
Quick Apply
SPECIAL PROJECT SUPERVISOR
Integrated Home Care Acquisition —Miramar, FL
- Hybrid work
- Microsoft Word
- Microsoft Outlook
- Management
- Paid training
- Wellness program
Quick Apply
13d
Office Coordinator
Esteem Braces & Aligners —Miami, FL
- $24 - $35 an hour
- Part-time
- Dental office
- HIPAA
- Mid-level
- Health insurance
- 401(k)
Quick Apply
Medical Biller Specialist
HEALTH MEDICAL BILLING INC. —Miami, FL
- $18 - $22 an hour
- Full-time
- Private practice
- HIPAA
- Mid-level
Quick Apply
14d
Insurance Verification Representative - Remote (Tri-County Area)
University of Miami —Medley, FL
- Full-time
- Remote
- Bilingual
- Computer literacy
- Mid-level
- Health insurance
- Dental insurance
Billing Financial Analyst, CBO
Jackson Health —Miami, FL
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
Payment Posting/Collections Specialist
Luis Hines & Associates P.A. —Miami, FL
- $20.00 - $29.25 an hour
- Part-time
- HIPAA
- Mid-level
- 3 years
- Flexible schedule
Quick Apply
12d
Medical Billing Specialist
VITAS Healthcare —Miramar, FL
- Full-time
- Microsoft Outlook
- Word processing
- Medical office experience
- Disability insurance
- Health insurance
Quick Apply
14d
Medical Biller (H)
University of Miami —Medley, FL
- Full-time
- Office
- High school diploma or GED
- 1 year
- Health insurance
- Dental insurance
Part time billing assistant
Blue Umbrella Psychiatry —Davie, FL
- $22 - $23 an hour
- Part-time
- Outpatient experience
- US work authorization
- In-person
Quick Apply
3d
Sr. Medical Posting Representative (H)
University of Miami —Medley, FL
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
13d

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medical claims jobs near miami, fl

Healthcare Claims and Fee for Service Supervisor

Provider Network Solutions LLC -
Miami, FL

Quick Apply

Job Details

Full-time
$63,000 - $65,000 a year
9 days ago

Qualifications

X12 EDI
Healthcare dispute resolution
Staff supervision
Process audits
EDI
Medicare
Team supervision
Medicare coding guidelines
Payment processing
Standard Operating Procedures (SOPs) implementation
Insurance dispute resolution
Overseeing healthcare denial management
Coaching
CMS
Regulatory compliance in claims processing
AI tools proficiency
HIPAA
Performance management
Medical claims processing software
CMS regulatory compliance
Policy & process development
Health insurance knowledge
Medicare regulations
Decision making
System testing
Payment posting in medical billing systems
Technical writing
Interdisciplinary policy and procedure development experience
Insurance investigations
Centers for Medicare & Medicaid Services (CMS) billing regulations

Full Job Description

Description:

Position Summary

The Claims and Fee for Service Supervisor manages the operational activities and staff of the Claims and Revenue Cycle Department in accordance with the Company guidelines, client needs, and State and Federal requirements.

Duties and Responsibilities

Oversee and manage daily activities and functions of the Claims Examiners processing claims for services that are capitated and Fee for Service with the health plan.
Responsible for overseeing the Revenue Cycle Management and Claims department’s daily operations, including but not limited to, running daily/frequent reports to ensure claims are processed timely, accurately, and in compliance with all federal and state healthcare plan laws and regulations. As well as, posting of all 835 payments.
Develop, implement, and update Claims Policies and Procedures to ensure compliance with CMS, Medicaid, HIPPA regulations, and health plan requirements.
Report overpayments, underpayments, and other irregularities.
Manage and close out claims open tickets and provider claims disputes.
Ensure optimal handling of all claims, investigate claims issues, and provide claims training for all business units.
Work together with Provider Servicing and participate in provider education, as necessary.
Maintain a fully comprehensive understanding of the covered benefits, coding, and reimbursement policies and contracts.
Act as Subject Matter Expert in issues related to claims processing, payment dispute resolution, cost containment, audit processes, and contract interpretation.
Actively collaborate with management and staff to ensure that “best practices” are followed and continually seek efficient and innovative processes, technologies, and approaches to optimize the use of resources and enhance operations.
Conduct analysis around various claims payment processes to ensure accuracy of system configuration and provider payments.
Investigate and resolve problem claims, while focusing on improving errors and problems to prevent future occurrences.
Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments.
Analyze and adjudicate complex claims when examiner is requesting Supervisor review.
Adjudicate claims by, including but not limited to, applying medical necessity guidelines, determining coverage and completing eligibility verification, identifying discrepancies and applying all cost containment measures when necessary.
Process medical claims by approving or denying documentation, calculating benefits due initiating a payment or denial letter when necessary.
Follow any center for Medicare and Medicaid (CMS) changes affecting claims processing.
Perform pre-payment audit and payment cycle.
Complies with performance standards as set forth by the department head.
Follow company policies, procedures, and guidelines to ensure legal compliance.
Update claims knowledge by participating in educational opportunities, whether system oriented or medical coding/terminology/interpretation.
Update and maintain departmental and specialty network standards of operating procedure (SOP).
Regularly meet with VP of Operations - to discuss and resolve reimbursement issues or billing obstacles.
Perform one-on-one meeting with the individual staff members.

Requirements:

Knowledge

Bachelor’s degree in health administration, Business, or a related field (or equivalent experience).
5+ years of experience in healthcare claims processing, Revenue Cycle Management, or medical billing; 2+ years in a supervisory or lead role preferred.
Strong understanding of CMS, Medicare, Medicaid, HIPAA, and healthcare compliance standards.
Proficiency with medical coding systems (ICD-10, CPT/HCPCS) and claims adjudication platforms.
Experience with payment posting, audits, dispute resolution, and claims system testing/UAT.
Experience using AI applications to streamline claims processing, improve accuracy in claim evaluations, and enhance decision-making efficiency.

Skills

Analytical & problem-solving skills to resolve complex claims, identify root causes, and ensure accurate payments.
Leadership & supervisory skills for managing daily operations, coaching staff, and conducting performance meetings.
Strong communication abilities to collaborate with providers, internal teams, and senior leadership.
Process & policy development skills, including writing SOPs, implementing best practices, and ensuring regulatory compliance.
Technical proficiency in claims platforms, RCM systems, Excel/reporting, and conducting system/UAT testing.

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Refine Your Search

medical claims jobs in miami, fl

Healthcare Claims and Fee for Service Supervisor

Medical Collector/radiology

Medical Biller

Credentialing Specialist

Manager Social Work & Care Management, Case Management, FT,9A-5:30P

Government Claims Admin 2, Remote

Administrative Assistant for Home Health Agency

Sr. Medical Biller (H)

Medical Biller – In-Person / In-House

Remote ABA Therapy Medical Billing Specialist

SPECIAL PROJECT SUPERVISOR

Office Coordinator

Medical Biller Specialist

Insurance Verification Representative - Remote (Tri-County Area)

Billing Financial Analyst, CBO

Payment Posting/Collections Specialist

Medical Billing Specialist

Medical Biller (H)

Part time billing assistant

Sr. Medical Posting Representative (H)

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