Hybrid-Sunrise, Florida. Position Summary. The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essentia...
Position Summary:The Marketing Manager is a creative and detail-oriented professional who leads the development and execution of marketing materials and communications that enhance member and provider engagement. This role requires a strong blend of strategic thinking, project management, and hands-on content creation, including graphic design, presentation development, and digital media coordination. The ideal candidate is highly collaborative, ...
Hybrid-Sunrise, Florida. Position Summary. The Utilization Management Behavioral Health Clinician works under general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration with the interdisciplinary team. The primary responsibilities are to perform the review of requests for behavioral health, substance use , and applied behavioral analysis service authorizations in order to assist with utilization of a...
Hybrid-Sunrise, Florida. Position Summary. The Service Desk Associate – Portal Support plays a key role in driving utilization of provider self-service tools. Responsible for processing provider portal access applications in a timely and accurate manner and promoting user understanding of portal functionality and navigation. This includes managing customer inquiries, successfully troubleshooting and resolving technical barriers, and maintaining e...
Planning Ahead: Internship Opportunities for. Summer 2026. – Get Started Early. POSITION SUMMARY. As a Provider Operations Intern, you will support the Provider Relations team in building strong relationships with healthcare providers and gaining insight into the operations of a managed care organization. This hands-on internship is ideal for students pursuing a degree in healthcare administration, public health, business, or a related field who ...
Planning Ahead: Internship Opportunities for. Summer 2026. – Get Started Early. POSITION SUMMARY. As a Provider Operations Intern, you will support the Provider Relations team in building strong relationships with healthcare providers and gaining insight into the operations of a managed care organization. This hands-on internship is ideal for students pursuing a degree in healthcare administration, public health, business, or a related field who ...
Fully on-site at Memorial Hospital Clinic, 4105 Pembroke Road, Hollywood, FL 33021. Position Summary. . . This position coordinates, educates, and provides expertise to members across the continuum of care from complex medical to chronic conditions as well as promote compliance with preventative care measures. The position coordinates healthcare interventions designed to facilitate care at the lowest level that can safely be achieved focusing on ...
Hybrid-Sunrise, Florida. Position Summary. The Business Intelligence Developer (BID) is responsible for developing projects using complex T-SQL language and Microsoft SQL Server Integrated Services. They are also responsible for assisting business teams in making critical business decisions through the development of reports/dashboards. Ultimately, their goal is to aid in fulfilling our mission of positively impacting the health and wellness of t...
Hybrid- Sunrise, Florida. Position Summary. . Responsible for the accurate and timely adjudication of health insurance claims in accordance with established production and quality department standards by performing the following duties. Essential Duties and Responsibilities. . Adjudicates and enters claims for all lines of business according to benefit plan designs and regulatory standards. Reviews claims based on coverage benefits, coding guidel...
